Pipeline flow-diverting stent

Perforator Infarction after Placement of a Pipeline Flow-Diverting Stent for an Unruptured A1 Aneurysm

Published ahead of print on February 11, 2010
doi: 10.3174/ajnr.A2034

American Journal of Neuroradiology 31:E43-E44, April 2010
© 2010 American Society of Neuroradiology

W.J. van Rooija and M. Sluzewskia
aDepartment of Radiology St. Elisabeth Ziekenhuis Tilburg, The Netherlands

Flow-diverting stents such as the Pipeline embolization device (PED; ev3, Irvine, California) or Silk (Balt, Montmorency, France) were recently introduced in clinical practice for the treatment of fusiform and wide-neck intracranial aneurysms. These stents are designed to divert the flow in the parent artery, with reduction of inflow in the aneurysm leading to thrombosis. The deviceshave 30%–35% metal surface-area coverage (as opposed to approximately 10% for conventional intracranial stents) to promote flow diversion and, at the same time, to keep open branch vessels and perforating arteries that are crossed by the device. Although these 2 required properties seem contradictory, the first clinical results are promising in terms of both effectiveness and safety.1

Recently, we treated a 68-year-old woman with an incidentally discovered large dumbbell aneurysm located on the left A1 segment (Fig 1A, –B) with a PED. Because the first PED that was placed shortened more than we expected, it did not completely cover the neck of the aneurysm, and a second PED was placed telescopically with overlap on the aneurysm neck only and with some protrusion in the middle cerebral artery (Fig 1C). Immediately after theprocedure, the patient appeared apathetic and hemiparetic on the right side. MR diffusion imaging showed infarction in the left basal ganglia in the territories of the lenticulostriate arteries arising from the A1 segment (Fig 1D, –E). In the following days, the hemiparesis gradually resolved, but cognition remained severely impaired with loss of initiative and attention, slowness and lack of …