title: Pipeline embolization for definitive endoluminal reconstruction of blister-type carotid aneurysms after clip wrapping.
abstract: BACKGROUND
  Ruptured blister aneurysms of the carotid artery are difficult to safely treat. We present a novel strategy of microsurgical clip wrapping of internal carotid artery blister aneurysms in the setting of acute rupture, followed by delayed placement of a pipeline embolization device for definitive treatment.
  
  
  METHODS
  We present two cases of ruptured blister aneurysms of the internal carotid artery treated by wrapping of the diseased segment of the vessel, followed by delayed deployment of a flow diverting stent once the patient was out of the vasospasm window but during the same hospitalization.
  
  
  RESULTS
  Clip wrapping followed by flow diversion in a delayed fashion results in anatomic remodeling of the diseased artery without a high morbidity.
  
  
  CONCLUSIONS
  A combined approach of acute surgical stabilization followed by definitive endovascular reconstruction may reduce hemorrhagic complications while improving long term treatment durability.
authors: Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors: M Yashar S
authors: MY
authors: Kalani
authors: Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors: Felipe C
authors: FC
authors: Albuquerque
authors: Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors: Michael
authors: M
authors: Levitt
authors: Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors: Peter
authors: P
authors: Nakaji
authors: Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors: Robert F
authors: RF
authors: Spetzler
authors: Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors: Cameron
authors: C
authors: McDougall
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D013525:Surgical Instruments
keywords: Aneurysm; Angiography; Artery; Brain; Stent