title: Failure of aneurysm occlusion by flow diverter: a role for surgical bypass and parent artery occlusion.
abstract: Flow diverters represent a paradigm shift in the treatment of aneurysms. However, unusual and poorly understood complications are being reported. We present a case of a giant internal carotid artery terminus aneurysm treated with flow diversion that progressively and symptomatically enlarged despite a reduction in the filling portion. Complete occlusion of the aneurysm and reduction in mass effect occurred through superficial temporal artery- middle cerebral artery bypass and parent artery occlusion. Incomplete aneurysm occlusion following flow diversion has been reported, but mechanisms and predisposing factors are speculative and definitive solutions have not been described. This case illustrates a potential solution.
authors.affiliation: Department of Neurosurgery, George Washington University Medical Faculty Associates, Washington, DC, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mattingly
authors.affiliation: Department of Neurology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Van Adel
authors.affiliation: Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Dyer
authors.affiliation: Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada.
authors.forename: Pablo
authors.initials: P
authors.lastname: Lopez-Ojeda
authors.affiliation: Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada.
authors.forename: David M
authors.initials: DM
authors.lastname: Pelz
authors.affiliation: Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Lownie
authors.affiliation: Department of Radiology, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Marotta
authors.affiliation: Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada.
authors.forename: Melfort
authors.initials: M
authors.lastname: Boulton
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D021721:Balloon Occlusion / Q000295:instrumentation / Q000379:methods*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D011859:Radiography; D017211:Treatment Failure
keywords: Aneurysm; Complication; Flow Diverter; Technology