PMC8309652_01
3D-reconstruction (A and B) and lateral view in digital subtraction angiography (C) of left ICA presenting the fenestration with a flow-associated aneurysm within the proximal bifurcation. Vessel lumen diameters in mm as depicted in b: 1-2.77; 2-1.51; 3-1.90; 4-3.73; 5-3.46.
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A digital subtraction angiography of cerebral vessels (DSA) was carried out and revealed a fenestration of the left ICA, segment C7 (subsegment 1), confirming the aneurysm (Figure 1).
PMC8309652_02
Angiographic follow-up via digital subtraction angiography of left ICA. (A and E) Directly after implantation of the pipeline device; (B and F) after three months; (C and G) after twelve months; (D and H) after twenty-four months. Note the transient relative hypoperfusion of the left anterior cerebral artery via left ICA three months post-interventionally that completely reversed during next follow-ups accompanied by transient intimal hyperplasia (white arrowhead).
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Directly post-implantation, and apart from an observed stagnation of contrast within the aneurysm (eclipse sign), there was no reduction in blood flow distal to the flow diverter (Figure 2A and E). Exemplary pictures are presented in Figure 2. The first follow up revealed an already completely occluded caudal fenestration branch accompanied by regressive aneurysm size, proximal intimal hyperplasia within the pipeline device, reduced ICA lumen diameter distal to the pipeline device (compare Figure 2A and B) and a hypoperfusion of the A1-segment of the left anterior cerebral artery, compensated by cross-over perfusion from the right ACI (Figure 3).
Coronal view of both ICAs via digital subtraction angiography three months after pipeline device implantation presenting left anterior cerebral artery hypoperfusion from left ICA (B) that is compensated via crossflow from right ICA (A).
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The first follow up revealed an already completely occluded caudal fenestration branch accompanied by regressive aneurysm size, proximal intimal hyperplasia within the pipeline device, reduced ICA lumen diameter distal to the pipeline device (compare Figure 2A and B) and a hypoperfusion of the A1-segment of the left anterior cerebral artery, compensated by cross-over perfusion from the right ACI (Figure 3).