Pipeline Embolization Device for the Treatment of Intracranial Pseudoaneurysms.

BACKGROUND: Intracranial pseudoaneurysms (PSAs) are associated with high rupture and mortality rates and have traditionally been treated by parent vessel sacrifice. There has been recent interest in using flow-diverting devices for treatment of these complex lesions while preserving flow through the parent artery. The objective of this study is to examine the safety and efficacy of these devices in the treatment of intracranial PSA. METHODS: We performed a multi-institutional retrospective study of intracranial PSAs treated with the Pipeline Embolization Device (PED) between 2014 and 2017 at 7 institutions. Complications and clinical and radiographic outcomes were reviewed. RESULTS: A total of 19 patients underwent PED placement for intracranial PSA. Iatrogenic injury and trauma comprised most etiologies in our series. The mean pseudoaneurysm diameter was 8.8 mm, and 18 of 19 PSAs (95%) involved the internal carotid artery (ICA). Multiple PEDs were deployed in a telescoping fashion in 7 patients (37%). Of the 18 patients with follow up imaging, 14 (78%) achieved complete pseudoaneurysm obliteration and 2 achieved near-complete obliteration (11%). Two patients (11%) were found to have significant pseudoaneurysm progression on short-term follow-up and required ICA sacrifice. No patients experienced new neurologic deficits or deterioration secondary to PED placement. No patients experienced bleeding or rebleeding from PSA. CONCLUSIONS: In well-selected patients, the use of flow-diverting stents may be a feasible alternative to parent vessel sacrifice. Given the high morbidity and mortality associated with PSA, we recommend short- and long-term radiographic follow-up for patients treated with flow-diverting stents.

Pseudohypoxic Brain Swelling After Elective Lumbar Spinal Surgery: Case Report.

Pseudohypoxic brain swelling (or the more recent term, postoperative intracranial hypotension-associated venous congestion) is a rare and potentially deadly complication that can occur after routine spine or brain surgery. The mechanism of this injury has been described as a rapid cerebral spinal fluid drainage leading to venous cerebral congestion. The clinical and radiographic findings mimic those found in a patient who has suffered an anoxic brain injury. We present the third reported case of postoperative intracranial hypotension-associated venous congestion following spinal surgery.

Incidentally Found Double Aortic Arch While Treating Posterior Inferior Cerebellar Artery Aneurysm: Conversion from Femoral to Radial Artery Access.

BACKGROUND: Asymptomatic double aortic arches are a unique occurrence. CASE DESCRIPTION: An incidental finding of a double aortic arch in an elderly male was discovered during workup of a transient ischemic attack. The following case presentation details an effective treatment approach in cerebrovascular stenting in a patient with variant aortic arch anatomy. The initial diagnostic cerebral angiogram was performed via transfemoral approach and was quite challenging. CONCLUSIONS: Faced with challenging anatomy, the radial artery approach is a viable option when navigating into the cerebrovascular anatomy for stenting when proximal variants such as a double aortic arch are identified.

Left Internal Carotid Artery Arising from the Right Cavernous Internal Carotid Artery: A Case Report.

Anatomical variations involving the internal carotid artery are uncommon. Herein, we present a very rare origin of the internal carotid artery. An adult female presented to the emergency department after falling. Imaging revealed that the left internal carotid artery arose from the contralateral cavernous segment of the internal carotid artery. Such a variation should be kept in mind by radiologists and surgeons who interpret and operate in this area, respectively.