title: Rupture of giant vertebrobasilar aneurysm following flow diversion: mechanical stretch as a potential mechanism for early aneurysm rupture.
abstract: A patient with a giant symptomatic vertebrobasilar aneurysm was treated by endoscopic third ventriculostomy for obstructive hydrocephalus followed by treatment of the aneurysm by flow diversion using a Pipeline Embolization Device. After an uneventful procedure and initial periprocedural period, the patient experienced an unexpected fatal subarachnoid hemorrhage 1 week later. Autopsy demonstrated extensive subarachnoid hemorrhage and aneurysm rupture (linear whole wall rupture). The patent Pipeline Embolization Device was in its intended location, as was the persistent coil occlusion of the distal left vertebral artery. The aneurysm appeared to rupture in a linear manner and contained a thick large expansile clot that seemed to disrupt or rupture the thin aneurysm wall directly opposite the basilar artery/Pipeline Embolization Device. We feel the pattern of aneurysm rupture in our patient supports the idea that the combination of flow diversion and the resulting growing intra-aneurysmal thrombus can create a mechanical force with the potential to cause aneurysm rupture.
authors.affiliation: Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Fox
authors.affiliation: Department of Neurosurgery, UTHSC, Semmes-Murphey, Memphis, Tennessee, USA.
authors.forename: William Edward
authors.initials: WE
authors.lastname: Humphries
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Vinodh T
authors.initials: VT
authors.lastname: Doss
authors.affiliation: Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hoit
authors.affiliation: Semmes-Murphey Clinic, Memphis, Tennessee, USA.
authors.forename: Lucas
authors.initials: L
authors.lastname: Elijovich
authors.affiliation: Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Arthur
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000209:etiology*; D001488:Basilar Artery / Q000473:pathology*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D017809:Fatal Outcome; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D013345:Subarachnoid Hemorrhage / Q000209:etiology*; D014696:Ventriculostomy; D014711:Vertebral Artery / Q000473:pathology*
keywords: Aneurysm; Complication; Flow Diverter; Hemorrhage; Hydrocephalus