title: Use of a flow-diverting stent for ruptured dissecting aneurysm treatment in a patient with sickle cell disease.
abstract: BACKGROUND
  Sickle cell disease (SCD) is a clinical phenotype that presents a unique challenge to the interventionalist, particularly when stent therapy is contemplated. Homozygous individuals are likely at increased risk for thromboembolic complications. There are no formal guidelines regarding antiplatelet therapy in the short or long term for intracranial stent use in SCD. The authors describe the novel use of a pipeline embolization device (PED) to treat a ruptured dissecting bilobed/fusiform vertebral artery V4 aneurysm in an SCD patient complicated by tortuous proximal anatomy and the anterior spinal artery arising from the diseased segment. Considerations regarding antiplatelet therapy in this scenario are discussed.
  
  
  METHODS
  A 50-year-old woman with homozygous recessive SCD was transported to the emergency department and presented with diffuse subarachnoid hemorrhage. CT angiography demonstrated a left-sided 3 × 5 mm fusiform bi-lobulated presumed dissecting vertebral artery aneurysm, immediately distal to the origin of the posterior inferior cerebellar artery (PICA). A PED was deployed within the V4 segment across the aneurysm. Post-treatment angiography showed patency of the parent artery, and patency of the "jailed" anterior spinal artery and of the PICA.
  
  
  CONCLUSIONS
  Selecting a treatment method in SCD patients with a ruptured intracranial aneurysm is challenging and there are no clinical trials comparing treatment methods in this population. The authors demonstrate that flow diversion is feasible in SCD, which has not been described in the literature. Additionally, the case stresses the peri- and post-procedural management of SCD, as well as long-term considerations with a flow-diverting stent in place.
authors.affiliation: Department of Medical Imaging, Division of Neuroradiology, St. Michael's Hospital, Canada.
authors.forename: A A
authors.initials: AA
authors.lastname: Dmytriw
authors.affiliation: Department of Neurosurgery, St. Michael's Hospital, Canada.
authors.forename: J L
authors.initials: JL
authors.lastname: Martinez
authors.affiliation: Department of Medical Imaging, Division of Neuroradiology, St. Michael's Hospital, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Marotta
authors.affiliation: Department of Medical Imaging, Division of Neuroradiology, St. Michael's Hospital, Canada.
authors.forename: W
authors.initials: W
authors.lastname: Montanera
authors.affiliation: Department of Neurosurgery, St. Michael's Hospital, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Cusimano
authors.affiliation: Department of Medical Imaging, Division of Neuroradiology, St. Michael's Hospital, Canada BharathaA@smh.ca.
authors.forename: A
authors.initials: A
authors.lastname: Bharatha
mesh_terms: D000755:Anemia, Sickle Cell / Q000150:complications*; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D020759:Anterior Spinal Artery Syndrome / Q000601:surgery*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D004632:Emergency Medical Services; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Anemia; dissecting vertebral artery aneurysm; endovascular techniques; intracranial aneurysm/surgery; pipeline embolization device; sickle cell