Case report: Covered stent placement to treat delayed aneurysmal rupture after flow diverter-assisted coil embolization

Xiheng Chen; Siming Gui; Linggen Dong; Longhui Zhang; Huijian Ge; Peng Liu; Youxiang Li; Ming Lv

doi:10.3389/fneur.2022.964733

Case report: Covered stent placement to treat delayed aneurysmal rupture after flow diverter-assisted coil embolization

Front Neurol. 2022 Nov 7:13:964733. doi: 10.3389/fneur.2022.964733. eCollection 2022.

Authors

Xiheng Chen^{1

2

3}, Siming Gui^{1

2

3}, Linggen Dong^{1

2}, Longhui Zhang^{1

2}, Huijian Ge^{1

2

3}, Peng Liu^{1

2

3}, Youxiang Li^{1

2

3}, Ming Lv^{1

2

3}

Affiliations

¹ Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
² Department of Interventional Neuroradiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
³ Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China.

Abstract

Introduction: Flow diverter (FD) placement is widely accepted as a treatment for large saccular intracranial aneurysms. Delayed aneurysmal rupture (DAR) after FD placement is potentially catastrophic and difficult to treat. To our knowledge, using a Willis covered stent (WCS) to treat DAR after placement of a Pipeline Flex embolization device (PFED) combined with coiling has not been previously reported.

Case presentation: A 49-year-old woman with an incidental asymptomatic large right supraclinoid internal carotid artery aneurysm was treated with PFED placement and adjunctive coiling. DAR causing subarachnoid hemorrhage occurred 11 hours after the procedure. Treatment using a WCS was successful and resulted in a favorable clinical outcome (modified Rankin scale score 2).

Conclusion: DAR after FD implantation requires isolation of the aneurysm from the cerebral circulation as soon as possible. WCS placement can achieve this immediately and occlude the aneurysm. We hope our case could provide new idea for similar cases in the future.

Keywords: case report; delayed aneurysm rupture; flow diverter; intracranial aneurysm; subarachnoid hemorrhage.

Publication types

Case Reports