CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2018; 07(03): 227-230
DOI: 10.1055/s-0037-1607030
Case Report
Neurological Surgeons' Society of India

Fatal Basilar Aneurysm Rupture 6 Months Following Pipeline Flow Diversion Treatment

Stylianos Pikis
1   Department of Neurosurgery, “Korgialenio Benakio” Red Cross Hospital of Athens, Athens, Greece
Tigran Petrosyan
1   Department of Neurosurgery, “Korgialenio Benakio” Red Cross Hospital of Athens, Athens, Greece
Eftychios Archontakis
2   Department of Interventional Neuroradiology, “Korgialenio Benakio” Red Cross Hospital of Athens, Athens, Greece
Georgios Arealis
1   Department of Neurosurgery, “Korgialenio Benakio” Red Cross Hospital of Athens, Athens, Greece
› Author Affiliations
Funding None.
Further Information

Publication History

Received: 15 February 2017

accepted: 25 May 2017

Publication Date:
12 October 2017 (online)


Background Very delayed aneurysmal rupture represents a rare, poorly understood, catastrophic complication of intracranial aneurysm flow diversion (FD) treatment.

Case Description A 48-year-old woman presented to the neurosurgical clinic for an elective admission 6-month post-FD treatment with a single pipeline embolization device (PED) treatment of a fusiform, large, midbasilar artery aneurysm. During her admission, the patient suffered a tonic-clonic seizure and collapsed. She was intubated and transferred for an urgent computed tomographic scan of the brain, which revealed subarachnoid hemorrhage and hydrocephalus. She was subsequently transferred to the operating room where an external ventricular drain was placed. Urgent diagnostic cerebral angiography revealed rupture of the previously treated aneurysm which was managed with deployment of a second PED and coil embolization of the right vertebral artery. Unfortunately, the patient succumbed to the disease 15 days later.

Conclusion The pathophysiologic mechanism responsible for delayed aneurysmal rupture post-FD treatment remains to be defined and may involve an acute rise in intra-aneurysmal pressures in a partially thrombosed aneurysm, continued hemodynamic stress on the aneurysmal wall due to persistent blood inflow, and thrombus-induced inflammation-mediated degradation the aneurysmal wall. Further clinical and anatomical studies are necessary to define the mechanisms responsible for delayed aneurysm ruptures and identify appropriate preventive measures.

  • References

  • 1 Kulcsár Z, Szikora I. The ESMINT Retrospective Analysis of Delayed Aneurysm Ruptures after flow diversion (RADAR) study. EJMINT Orig Artic. 2012: 1244000078 (October). Accessed June 1, 2017
  • 2 Kulcsár Z, Houdart E, Bonafé A. et al. Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 2011; 32 (01) 20-25
  • 3 Chalouhi N, Tjoumakaris S, Phillips JLH. et al. A single pipeline embolization device is sufficient for treatment of intracranial aneurysms. Am J Neuroradiol 2014; 35 (08) 1562-1566
  • 4 Saatci I, Yavuz K, Ozer C, Geyik S, Cekirge HS. Treatment of intracranial aneurysms using the pipeline flow-diverter embolization device: a single-center experience with long-term follow-up results. Am J Neuroradiol 2012; 33 (08) 1436-1446
  • 5 Monteith SJ, Tsimpas A, Dumont AS. et al. Endovascular treatment of fusiform cerebral aneurysms with the pipeline embolization device. J Neurosurg 2014; 120 (04) 945-954
  • 6 Berge J, Biondi A, Machi P. et al. Flow-diverter silk stent for the treatment of intracranial aneurysms: 1-year follow-up in a multicenter study. Am J Neuroradiol 2012; 33 (06) 1150-1155
  • 7 Rouchaud A, Brinjikji W, Lanzino G, Cloft HJ, Kadirvel R, Kallmes DF. Delayed hemorrhagic complications after flow diversion for intracranial aneurysms: a literature overview. Neuroradiology 2016; 58 (02) 171-177
  • 8 Briganti F, Leone G, Napoli M, Lauriola W, Florio F, Maiuri F. Early fatal hemorrhage after endovascular treatment of a giant aneurysm with flow diverter device and coils. Clin Neuroradiol 2015; 25 (02) 201-205
  • 9 Cebral JR, Mut F, Raschi M. et al. Aneurysm rupture following treatment with flow-diverting stents: computational hemodynamics analysis of treatment. Am J Neuroradiol 2011; 32 (01) 27-33
  • 10 Hassan T, Ahmed YM, Hassan AA. The adverse effects of flow-diverter stent-like devices on the flow pattern of saccular intracranial aneurysm models: computational fluid dynamics study. Acta Neurochir (Wien) 2011; 153 (08) 1633-1640
  • 11 Larrabide I, Aguilar ML, Morales HG. et al. Intra-aneurysmal pressure and flow changes induced by flow diverters: relation to aneurysm size and shape. Am J Neuroradiol 2013; 34 (04) 816-822
  • 12 Shobayashi Y, Tateshima S, Kakizaki R, Sudo R, Tanishita K, Viñuela F. Intra-aneurysmal hemodynamic alterations by a self-expandable intracranial stent and flow diversion stent: high intra-aneurysmal pressure remains regardless of flow velocity reduction. J Neurointerv Surg 2013; 5 (Suppl. 03) iii38-iii42
  • 13 Berge J, Tourdias T, Moreau JF, Barreau X, Dousset V. Perianeurysmal brain inflammation after flow-diversion treatment. Am J Neuroradiol 2011; 32 (10) 1930-1934
  • 14 Monrad P, Sannagowdara K, Bozarth X. et al. Haemodynamic response associated with both ictal and interictal epileptiform activity using simultaneous video electroencephalography/near infrared spectroscopy in a within-subject study. J Near Infrared Spectrosc 2015; 23 (04) 209-218
  • 15 Diehl B, Knecht S, Deppe M, Young C, Stodieck SRG. Cerebral hemodynamic response to generalized spike-wave discharges. Epilepsia 1998; 39 (12) 1284-1289