title: Fatal arterial rupture during angioplasty of a flow diverter in a recurrent, previously Y-stented giant MCA bifurcation aneurysm.
abstract: OBJECTIVE
  A patient with a previously Y-stented giant left middle cerebral artery (MCA) bifurcation aneurysm returned with a recurrence.
  
  
  METHODS
  A flow diverter (FD) was deployed through one limb of the high-porosity Y-stenting construction. The proximal FD failed to expand and an attempt at balloon angioplasty led to fatal rupture of the MCA.
  
  
  RESULTS
  Autopsy demonstrated subarachnoid hemorrhage, vessel rupture and fracture of the proximal high-porosity stent. Microscopic photographs showed that the FD had failed to open because the guiding wire had inadvertently exited and re-entered the proximal segment of the high-porosity stent partially incorporated to the wall of the MCA. Balloon dilatation of the FD which had remained collapsed between the stent and the vessel wall caused fracture of the stent and rupture of the artery.
  
  
  CONCLUSIONS
  Angioplasty and flow-diversion of previously Y-stented aneurysms can lead to serious complications.
authors.affiliation: Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Department of Radiology, Service of Neuroradiology, Canada.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Gentric
authors.affiliation: Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Department of Radiology, Service of Neuroradiology, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Fahed
authors.affiliation: University of Alberta Hospital, Mackenzie Health Sciences Centre, Department of Surgery, Division of Neurosurgery, Canada.
authors.forename: Tim E
authors.initials: TE
authors.lastname: Darsaut
authors.affiliation: Centre Hospitalier de l'Université de Montréal Research Centre (CRCHUM), Notre-Dame Hospital, Interventional Neuroradiology Research Laboratory, Canada.
authors.forename: Igor
authors.initials: I
authors.lastname: Salazkin
authors.affiliation: Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Department of Radiology, Service of Neuroradiology, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Roy
authors.affiliation: Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Department of Radiology, Service of Neuroradiology, Canada jean.raymond@umontreal.ca.
authors.forename: Jean
authors.initials: J
authors.lastname: Raymond
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000209:etiology*; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D002533:Cerebral Angiography; D004868:Equipment Failure; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D012008:Recurrence; D015607:Stents
keywords: Flow diverter; coiling; complication; intracranial aneurysm; stenting