title: Flow diversion in vasculitic intracranial aneurysms? Repair of giant complex cavernous carotid aneurysm in polyarteritis nodosa using Pipeline embolization devices: first reported case.
abstract: Intracranial aneurysms in polyarteritis nodosa (PAN) are exceedingly rare lesions with unpredictable behavior that pose real challenges to microsurgical and endovascular interventions owing to their inflammatory nature. We introduce a safe and effective alternative for treating these aneurysms using Pipeline embolization devices (PEDs). A 20-year-old man presented with diplopia, headaches, chronic abdominal pain, and weight loss. Diagnostic evaluations confirmed PAN, including bilateral giant cavernous carotid aneurysms. Cyclophosphamide and steroids achieved significant and sustained clinical improvement, with a decision to follow the aneurysms serially. Seven years later the left unruptured aneurysm enlarged, causing a sudden severe headache and a cavernous sinus syndrome. Treatment of the symptomatic aneurysm was pursued using flow diversion (PED) and the internal carotid artery was successfully reconstructed with a total of four overlapping PEDs. At 6 months follow-up, complete exclusion of the aneurysm was demonstrated, with symptomatic recovery. This is the first description of using a flow-diverting technique in an inflammatory vasculitis. In this case, PEDs not only attained a definitive closure of the aneurysm but also reconstructed the damaged and fragile arterial segment affected with vasculitis.
authors.affiliation: Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Jaime
authors.initials: J
authors.lastname: Martinez Santos
authors.affiliation: Department of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Zul
authors.initials: Z
authors.lastname: Kaderali
authors.affiliation: Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Julian
authors.initials: J
authors.lastname: Spears
authors.affiliation: Department of Rheumatology, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Laurence A
authors.initials: LA
authors.lastname: Rubin
authors.affiliation: Department of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Marotta
mesh_terms: D001807:Blood Vessel Prosthesis; D002340:Carotid Artery Diseases / Q000628:therapy*; D020226:Cavernous Sinus Thrombosis / Q000150:complications; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005471:Fluoroscopy; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D010488:Polyarteritis Nodosa / Q000150:complications*; D016896:Treatment Outcome; D020293:Vasculitis, Central Nervous System / Q000628:therapy*; D055815:Young Adult
keywords: Aneurysm; Flow Diverter; Vasculitis