Background: Treatment of internal carotid ruptured blister aneurysms (IC-RBA) presents many challenges to neurosurgeons due to a high propensity for re-bleeding during intervention. The role of a pipeline embolization device (PED) in the treatment of this challenging aneurysm subtype remains undefined despite theoretical advantages.
Objective: The authors present a series of 11 patients treated with a PED and discuss the management and results of this novel application of flow diverters.
Methods: Medical records of patients who presented with IC-RBA from May 2011 to March 2013 were retrospectively reviewed at six institutions in the United States. All relevant data were independently compiled.
Results: A total of 12 IC-RBA in 11 patients were treated during the study period. Nine (75%) were treated with a single PED, one was treated with two PEDs, one was treated with coils and one PED, and one was treated with coils and two PEDs. Three (27%) had major perioperative complications: middle cerebral artery territory infarction, vision loss, and death. Seven patients demonstrated a complete obliteration of the aneurysm in postoperative imaging. Early clinical outcomes were favorable (mRS 0-2) in all 10 survivors.
Conclusion: This study demonstrates feasibility and safety of using PED to treat IC-RBA with fair initial results. The proper introduction and management of antiplatelet regimen is key for successful results. Bleeding complications related to dual antiplatelet therapy were similar to the previous studies of stent-assisted coiling for the same population. Larger cohort analysis is needed to define the precise role of flow diverters in the treatment of IC-RBA.
Copyright (C) by the Congress of Neurological Surgeons