Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home

User menu

  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

ASHNR American Society of Functional Neuroradiology ASHNR American Society of Pediatric Neuroradiology ASSR
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds

AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

LetterLetter

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

W.J. van Rooij and M. Sluzewski
American Journal of Neuroradiology April 2010, 31 (4) E43-E44; DOI: https://doi.org/10.3174/ajnr.A2034
W.J. van Rooij
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
M. Sluzewski
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • Responses
  • References
  • PDF
Loading

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 devices have 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 the procedure, 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 spontaneity, and global memory dysfunction.

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

A 68-year-old woman with an incidentally discovered aneurysm. A and B, 3D and 2D angiograms show a dumbbell-shaped aneurysm on the left A1 segment. C, Position of 2 telescopically placed Pipeline stents. Note stasis of contrast material inside the aneurysm. D and E, Diffusion-weighted MR images demonstrate basal ganglia infarctions.

This case illustrates that perforator arteries may become occluded after placement of a PED over the orifices. The frequency of this complication is not yet known. As in our patient, occlusion of perforator arteries can have serious clinical consequences. This risk of perforator occlusion should be carefully balanced against the possible benefits of the PED, especially in patients with unruptured aneurysms, the main target group of PED. Many unruptured aneurysms can be treated with other techniques, both endovascular and surgical. As for now, the best indication for the PED seems fusiform aneurysms without apparent side branches or perforators.

Reference

  1. 1.↵
    1. Lylyk P,
    2. Miranda C,
    3. Ceratto R,
    4. et al
    . Curative endovascular reconstruction of cerebral aneurysms with the Pipeline embolization device: the Buenos Aires experience. Neurosurgery 2009; 64: 632–42, discussion 642–43; quiz N6
    CrossRefPubMed
  • Copyright © American Society of Neuroradiology
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 31 (4)
American Journal of Neuroradiology
Vol. 31, Issue 4
1 Apr 2010
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Perforator Infarction after Placement of a Pipeline Flow-Diverting Stent for an Unruptured A1 Aneurysm
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Cite this article
W.J. van Rooij, M. Sluzewski
Perforator Infarction after Placement of a Pipeline Flow-Diverting Stent for an Unruptured A1 Aneurysm
American Journal of Neuroradiology Apr 2010, 31 (4) E43-E44; DOI: 10.3174/ajnr.A2034

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
0 Responses
Respond to this article
Share
Bookmark this article
Perforator Infarction after Placement of a Pipeline Flow-Diverting Stent for an Unruptured A1 Aneurysm
W.J. van Rooij, M. Sluzewski
American Journal of Neuroradiology Apr 2010, 31 (4) E43-E44; DOI: 10.3174/ajnr.A2034
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • Reference
  • Figures & Data
  • Info & Metrics
  • Responses
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish?
  • Flow diversion covering the M1 origin as a last resort
  • Comparison of Pipeline Embolization Device Sizing Based on Conventional 2D Measurements and Virtual Simulation Using the Sim&Size Software: An Agreement Study
  • Transient in-stent stenosis: a common finding after flow diverter implantation
  • Endovascular isolation of intracranial blood blister-like aneurysms with Willis covered stent
  • Endovascular flow diversion for treatment of anterior communicating artery region cerebral aneurysms: a single-center cohort of 50 cases
  • Use of flow diverters in the treatment of unruptured saccular aneurysms of the anterior cerebral artery
  • Pipeline embolization device for the treatment of vertebral artery aneurysms: the fate of covered branch vessels
  • Posterior Inferior Cerebellar Artery Patency after Flow-Diverting Stent Treatment
  • p64 Flow Modulation Device in the treatment of intracranial aneurysms: initial experience and technical aspects
  • Pipeline endovascular device for the treatment of intracranial aneurysms at the level of the circle of Willis and beyond: multicenter experience
  • Anterior Choroidal Artery Patency and Clinical Follow-Up after Coverage with the Pipeline Embolization Device
  • Extra-Aneurysmal Flow Modification Following Pipeline Embolization Device Implantation: Focus on Regional Branches, Perforators, and the Parent Vessel
  • Endovascular Treatment of Middle Cerebral Artery Aneurysms with Flow Modification with the Use of the Pipeline Embolization Device
  • Treatment of a pediatric recurrent fusiform middle cerebral artery (MCA) aneurysm with a flow diverter
  • New Generation of Flow Diverter (Surpass) for Unruptured Intracranial Aneurysms: A Prospective Single-Center Study in 37 Patients
  • Intra-Aneurysmal Pressure and Flow Changes Induced by Flow Diverters: Relation to Aneurysm Size and Shape
  • Reconstructive Endovascular Treatment of Fusiform and Dissecting Basilar Trunk Aneurysms with Flow Diverters, Stents, and Coils
  • Pipeline Embolization Device in Aneurysmal Subarachnoid Hemorrhage
  • Treatment of a pediatric recurrent fusiform middle cerebral artery (MCA) aneurysm with a flow diverter
  • Long-Term Clinical and Imaging Follow-Up of Complex Intracranial Aneurysms Treated by Endovascular Parent Vessel Occlusion
  • Treatment of Intracranial Aneurysms Using the Pipeline Flow-Diverter Embolization Device: A Single-Center Experience with Long-Term Follow-Up Results
  • Safety of the Pipeline Embolization Device in Treatment of Posterior Circulation Aneurysms
  • Reconstructive Endovascular Treatment of Fusiform or Ultrawide-Neck Circumferential Aneurysms with Multiple Overlapping Enterprise Stents and Coiling
  • Patency of Branches after Coverage with Multiple Telescoping Flow-Diverter Devices: An In Vivo Study in Rabbits
  • Flow Diversion for Intracranial Aneurysms: A Review
  • MR Imaging of Partially Thrombosed Cerebral Aneurysms: Characteristics and Evolution
  • Crossref (94)
  • Google Scholar

This article has been cited by the following articles in journals that are participating in Crossref Cited-by Linking.

  • Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections
    Sebastian Fischer, Zsolt Vajda, Marta Aguilar Perez, Elisabeth Schmid, Nikolai Hopf, Hansjörg Bäzner, Hans Henkes
    Neuroradiology 2012 54 4
  • Treatment of Intracranial Aneurysms Using the Pipeline Flow-Diverter Embolization Device: A Single-Center Experience with Long-Term Follow-Up Results
    I. Saatci, K. Yavuz, C. Ozer, S. Geyik, H.S. Cekirge
    American Journal of Neuroradiology 2012 33 8
  • Flow Diversion for Intracranial Aneurysms
    Pietro I. D'Urso, Giuseppe Lanzino, Harry J. Cloft, David F. Kallmes
    Stroke 2011 42 8
  • Intracranial Aneurysms: Midterm Outcome of Pipeline Embolization Device—A Prospective Study in 143 Patients with 178 Aneurysms
    Simon Chun-Ho Yu, Ching-Kwong Kwok, Pui-Wai Cheng, Kwong-Yau Chan, Samuel Shun Lau, Wai-Man Lui, Ka-Ming Leung, Raymand Lee, Harold Kin-Ming Cheng, Yuk-Ling Cheung, Chi-Ming Chan, George Kwok-Chu Wong, Joyce Wai-Yi Hui, Yiu-Chung Wong, Chong-Boon Tan, Wai-Lun Poon, Kai-Yuen Pang, Alain Kai-Sing Wong, Kai-Hung Fung
    Radiology 2012 265 3
  • Safety of the Pipeline Embolization Device in Treatment of Posterior Circulation Aneurysms
    T.J. Phillips, J.D. Wenderoth, C.C. Phatouros, H. Rice, T.P. Singh, L. Devilliers, V. Wycoco, S. Meckel, W. McAuliffe
    American Journal of Neuroradiology 2012 33 7
  • New Generation of Flow Diverter (Surpass) for Unruptured Intracranial Aneurysms
    Joost De Vries, Jeroen Boogaarts, Anouk Van Norden, Ajay K. Wakhloo
    Stroke 2013 44 6
  • Endovascular Treatment of Middle Cerebral Artery Aneurysms with Flow Modification with the Use of the Pipeline Embolization Device
    K. Yavuz, S. Geyik, I. Saatci, H.S. Cekirge
    American Journal of Neuroradiology 2014 35 3
  • Pipeline Flow-Diverter Stent for Endovascular Treatment of Intracranial Aneurysms: Preliminary Experience in 20 Patients with 27 Aneurysms
    Boris Lubicz, Laurent Collignon, Gaï Raphaeli, Olivier De Witte
    World Neurosurgery 2011 76 1-2
  • Flow-diverter devices in the treatment of intracranial aneurysms: A meta-analysis and systematic review
    Xianli Lv, Hongchao Yang, Peng Liu, Youxiang Li
    The Neuroradiology Journal 2016 29 1
  • Pipeline Embolization Device for Intracranial Aneurysm: A Systematic Review
    G. K. K. Leung, A. C. O. Tsang, W. M. Lui
    Clinical Neuroradiology 2012 22 4

More in this TOC Section

  • Reply:
  • Brain AVM’s Nidus: What if We Hadn’t Understood Anything?
  • Letter to the Editor regarding “Automated Volumetric Software in Dementia: Help or Hindrance to the Neuroradiologist?”
Show more LETTERS

Similar Articles

Advertisement

Indexed Content

  • Current Issue
  • Accepted Manuscripts
  • Article Preview
  • Past Issues
  • Editorials
  • Editor's Choice
  • Fellows' Journal Club
  • Letters to the Editor
  • Video Articles

Cases

  • Case Collection
  • Archive - Case of the Week
  • Archive - Case of the Month
  • Archive - Classic Case

More from AJNR

  • Trainee Corner
  • Imaging Protocols
  • MRI Safety Corner
  • Book Reviews

Multimedia

  • AJNR Podcasts
  • AJNR Scantastics

Resources

  • Turnaround Time
  • Submit a Manuscript
  • Submit a Video Article
  • Submit an eLetter to the Editor/Response
  • Manuscript Submission Guidelines
  • Statistical Tips
  • Fast Publishing of Accepted Manuscripts
  • Graphical Abstract Preparation
  • Imaging Protocol Submission
  • Evidence-Based Medicine Level Guide
  • Publishing Checklists
  • Author Policies
  • Become a Reviewer/Academy of Reviewers
  • News and Updates

About Us

  • About AJNR
  • Editorial Board
  • Editorial Board Alumni
  • Alerts
  • Permissions
  • Not an AJNR Subscriber? Join Now
  • Advertise with Us
  • Librarian Resources
  • Feedback
  • Terms and Conditions
  • AJNR Editorial Board Alumni

American Society of Neuroradiology

  • Not an ASNR Member? Join Now

© 2025 by the American Society of Neuroradiology All rights, including for text and data mining, AI training, and similar technologies, are reserved.
Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire