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Case Reports
. 2016 Jul 19:2016:bcr2016012506.
doi: 10.1136/bcr-2016-012506.

Rapid delayed growth of ruptured supraclinoid blister aneurysm after successful flow diverting stent treatment

Stefan Thomas Lang  1 , Zarina Assis  1 , John H Wong  1 , William Morrish  1 , Alim P Mitha  1
Affiliations
Case Reports

Rapid delayed growth of ruptured supraclinoid blister aneurysm after successful flow diverting stent treatment

Stefan Thomas Lang et al. BMJ Case Rep. .

Abstract

A 62-year-old woman presented with a subarachnoid hemorrhage secondary to a ruptured right supraclinoid internal carotid artery blister aneurysm. She was treated in an emergent fashion with two flow diverting pipeline embolization devices (PED) deployed in a telescoping fashion. CT angiography performed for unrelated reasons at 7 months showed successful treatment of the aneurysm without evidence of residual aneurysm. However, a follow-up digital subtraction angiogram performed at 9 months showed a large aneurysm in a modified position compared with the original aneurysm. This is the first case of rapid regrowth of a supraclinoid blister aneurysm after successful treatment with a PED, and demonstrates the need for close follow-up for similar aneurysms treated with this novel device.

Keywords: Aneurysm; Device; Flow Diverter; Subarachnoid.

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Figures

Figure 1
Figure 1
Initial non-contrast CT (A, B) showing grade 4 subarachnoid hemorrhage, predominantly in the right suprasellar cistern. CT angiogram (C, D) showing a 2 mm blister involving the right supraclinoid internal carotid artery (arrow).
Figure 2
Figure 2
Cerebral angiogram of the right internal carotid artery (ICA) (frontal image (left) and three-dimensional image (right)), showing significant interval growth of the right supraclinoid ICA aneurysm.
Figure 3
Figure 3
Final digital subtraction angiogram image after placing two telescoping pipeline flow diverters with good aneurysm neck coverage. Arrows demonstrate proximal and distal ends of the stent.
Figure 4
Figure 4
Right internal carotid artery digital subtraction angiogram on day 13 showing no enlargement of the pseudoaneurysm (arrow).
Figure 5
Figure 5
Seven month follow-up CT angiogram showing no residual aneurysm.
Figure 6
Figure 6
Nine month follow-up digital subtraction angiogram shows recurrence of the right supraclinoid internal carotid artery aneurysm (arrow, A). Post deployment of the third pipeline flow diverter with contrast stagnation within the aneurysm (B).
See this image and copyright information in PMC

References

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