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Case Reports
. 2021 Summer;21(2):190-193.
doi: 10.31486/toj.19.0122.

Iatrogenic Middle Cerebral Artery Ruptured Pseudoaneurysm Successfully Treated With a Pipeline Embolization Device

Tyler Scullen  1   2 , Mansour Mathkour  1   2 , Jessica R Carr  3 , Aaron S Dumont  1   3 , Peter S Amenta  1   3
Affiliations
Case Reports

Iatrogenic Middle Cerebral Artery Ruptured Pseudoaneurysm Successfully Treated With a Pipeline Embolization Device

Tyler Scullen et al. Ochsner J. 2021 Summer.

Abstract

Background: Endovascular advances have shifted the treatment algorithms for traumatic intracranial pseudoaneurysms (IPs) from vessel sacrifice to reconstruction. The Pipeline embolization device (PED) is a flow-diverting stent that promotes endothelialization across the lesion and reconstitutes the parent vessel lumen. Case Report: A 66-year-old male with a history of a right orbital apex lesion presented for biopsy with ophthalmology. Ophthalmology performed a right lateral orbitotomy complicated by brisk arterial bleeding from a proximal right middle cerebral artery (MCA) pseudoaneurysm. The MCA pseudoaneurysm was treated endovascularly with a PED, resulting in immediate stasis of contrast within the lesion without compilation. Interval follow-up angiograms 6 weeks and 6 months after the procedure showed no evidence of recurrence and a widely patent stent. Conclusion: The PED provided a rapid, minimally invasive, and durable treatment option for an acutely ruptured IP. We illustrate that endovascular management with flow diversion can be effectively used in select cases and provides a way to reconstruct the damaged vessel lumen and obliterate the aneurysm.

Keywords: Dual anti-platelet therapy; embolization device; intracranial aneurysm; middle cerebral artery; rupture; subarachnoid hemorrhage.

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Figures

Figure 1.
Figure 1.
Axial magnetic resonance images of the brain (A) without and (B) with contrast show persistent enhancing right orbital apex mass prior to the planned ophthalmology procedure. (C) Axial computed tomography (CT) scan of the head demonstrates subarachnoid hemorrhage immediately following the transorbital approach to the orbital apex. (D) Axial CT angiography suggests mild irregularity of the right M1 segment (arrow).
Figure 2.
Figure 2.
(A) Initial anterior-posterior digital subtraction angiography of the right internal carotid artery demonstrates a right M1 segment pseudoaneurysm (arrow) arising from the ventral surface of the proximal M1 segment. (B) Repeat injection immediately after Pipeline embolization device deployment shows stasis on contrast (arrow) in the late arterial phase.
Figure 3.
Figure 3.
(A) Postoperative day 6 digital cerebral angiography (DSA) of the right internal carotid artery shows complete obliteration of the pseudoaneurysm. (B) Six-month follow-up DSA demonstrates persistent and complete obliteration and a widely patent Pipeline embolization device.
See this image and copyright information in PMC

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