PMC6337989_01
(a) Lateral angiogram demonstrating a large 20 mm x 24 mm x 22 mm (width x depth x height) left cavernous carotid wide-necked aneurysm. (b) Lateral skull X-ray demonstrating two overlapping pipeline embolization device (4.5 mm x 20 mm and 5 mm x 20 mm, Medtronic Inc., Minneapolis, MN, USA) spanning from the left supraclinoid internal carotid artery to the vertical segment of the petrous internal carotid artery. (c) Lateral angiogram demonstrating contrast stasis within the aneurysm sac following placement of the two overlapping pipeline embolization device. (d) Lateral angiogram demonstrating significant decrease aneurysm sac filling with a small residual component measuring 7 mm x 8 mm at the anterior genu of the cavernous segment of the internal carotid artery at 4 months after pipeline embolization device placement. (e) Lateral angiogram demonstrating a large regrowth of the aneurysm, measuring 25 mm x 28 mm x 18 mm, at 10 months after pipeline embolization device placement. (f) Axial computed tomography angiogram demonstrating complete coverage of the aneurysm neck by the pipeline embolization device at 10 months after treatment
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F1
In March 2017, the patient underwent placement of two overlapping PED (4.5 mm x 20 mm and 5 mm x 20 mm) through the Marksman microcatheter (Medtronic Inc., Minneapolis, MN, USA) and Sofia intermediate catheter (MicroVention, Aliso Viejo, CA) for the treatment of her large left cavernous carotid aneurysm [Figure 1a]. The entire flow-diverter stent construct spanned from the supraclinoid ICA to the vertical segment of the petrous ICA [Figure 1b]. Final postprocedural control angiogram demonstrated significant contrast stasis within the aneurysm sac [Figure 1c] while fully heparinized. The patient returned for a follow-up angiogram at 4 months following treatment, which demonstrated remodeling of the ICA with only minimal filling of the aneurysm measuring 7 mm x 8 mm x 7 mm at the anterior genu of the cavernous segment of the ICA [Figure 1d]. In a subsequent angiogram, at 10 months after treatment, the aneurysm had regrown with interval expansion now measuring 25 mm x 28 mm x 18 mm [Figure 1e]. Computed tomography (CT) angiogram demonstrated complete PED coverage of the aneurysm neck [Figure 1f].