Endovascular Treatment of a Fusiform Aneurysm at the M3-M4 Junction of the Middle Cerebral Artery Using the Pipeline Embolization Device.
BACKGROUND
Peripheral fusiform cerebral aneurysms remain difficult to treat. Current surgical approaches to the treatment of fusiform aneurysms include wrapping, clip occlusion or vessel reconstruction without parent vessel sacrifice, and aneurysm trapping with or without bypass, although these may carry high morbidity (36%). Classic endovascular approaches to the treatment of peripheral aneurysms include selective or parent artery occlusion, which imparts the risk of distal infarction. It may be possible to use a flow diversion device off label to treat the aneurysm and preserve flow to the distal territory.


METHODS
After a presyncopal event, a patient was found to have an unruptured fusiform aneurysm at the junction of the M3 and M4 segments of the right middle cerebral artery. After initiating dual antiplatelet therapy, the aneurysm was successfully treated with a Pipeline embolization device. Three months after treatment, the aneurysm has completely thrombosed, the parent artery remains widely patent, and the patient remains at her neurologic baseline.


CONCLUSIONS
Flow diversion devices may provide the neurointerventional surgeon with an opportunity to treat fusiform peripheral aneurysms and preserve flow to the distal territory.
Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA.
Christopher R
CR
Durst
Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA.
H Robert
HR
Hixson
Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Paul
P
Schmitt
Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA.
Jean M
JM
Gingras
Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA. Electronic address: rc9dd@hscmail.mcc.virginia.edu.
R Webster
RW
Crowley
D004621:Embolization, Therapeutic / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000295:instrumentation*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D020768:Middle Cerebral Artery
Angiography; Cerebral aneurysm; Embolization; Flow diversion; Fusiform; Pipeline; Pipeline embolization device