title: Endovascular flow diversion therapy for an actively hemorrhaging aneurysm after intraoperative rupture.
abstract: We report a 56-year-old woman who had an unruptured posterior communicating artery aneurysm. Given the size and location of the aneurysm, as well as her history of smoking and age, she received endovascular treatment with the pipeline embolization device (PED; ev3 Endovascular, Plymouth, MN, USA), complicated by intraoperative rupture (IOR). Flow diversion therapy with the PED has become an increasingly popular method of aneurysmal embolization and parent vessel remodeling. While its on-label approval is for large unruptured aneurysms of the internal carotid artery, success in off-label scenarios has been reported, including ruptured aneurysms. IOR complicates endovascular aneurysm treatment and can cause devastating morbidity or mortality, necessitating acute embolization of the hemorrhaging aneurysm. This patient illustrates the feasibility of treating an IOR with a stand-alone flow diversion device by using PED.
authors.affiliation: Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, N-1019 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA. Electronic address: daniel.ikeda@osumc.edu.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Ikeda
authors.affiliation: Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, N-1019 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Marlin
authors.affiliation: Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, N-1019 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Shaw
authors.affiliation: Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, N-1019 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA.
authors.forename: David
authors.initials: D
authors.lastname: Dornbos
authors.affiliation: Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, N-1019 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210, USA.
authors.forename: Ciarán J
authors.initials: CJ
authors.lastname: Powers
mesh_terms: D017542:Aneurysm, Ruptured / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D007431:Intraoperative Complications / Q000601:surgery*; D008875:Middle Aged
keywords: Endovascular therapy; Flow diverter; Intracranial aneurysm; Intraoperative rupture; Pipeline embolization device; Subarachnoid hemorrhage