Article Figures & Data
Figures
- Fig 1.
A 30-year-old woman with a fusiform basilar trunk sidewall 12-mm aneurysm previously treated with an Enterprise stent some months before release of PED. A, Anteroposterior (AP) vertebrobasilar DSA demonstrates the stent (black arrowheads) within the patent aneurysm. B, High-resolution flat-panel CT scan after deployment of a single PED within the Enterprise stent demonstrates that the PED is not fully open and appears constrained within the stent (white arrow). C, AP DSA 6-months after PED insertion demonstrates some slowing of sac emptying but no change in aneurysm size. AP DSA at 11 months (not shown) was unchanged, and an angioplasty of the PED was performed by using a HyperGlide balloon (ev3), with mild improvement in appearance. The patient remained on clopidogrel. D, AP DSA, at 18 months' post-PED and 7 months' postangioplasty, demonstrates marked reduction in the size of the sac. The patient remains on clopidogrel.
- Fig 2.
A 55-year-old man with recent-onset homonymous hemianopia. A 16-mm superior hypophyseal aneurysm points upwards, compressing the chiasm. A, Lateral internal carotid artery DSA demonstrates the deployed PED well covering the aneurysm neck (black arrow). B, Sagittal CTA 48 hours after PED deployment demonstrates the distal margin of PED just covering the neck. C, Sagittal CTA at 1 month demonstrates proximal migration of the PED with a jet into the aneurysm. D, Sagittal CTA 1 month after the second PED demonstrates a good position of the PED and occlusion of the aneurysm, which was confirmed at 6-month DSA (not shown). Clopidogrel was stopped. The homonymous hemianopia resolved at 5 months, and 12-month MR imaging (not shown) demonstrated marked reduction in the size of the thrombosed aneurysm sac.
- Fig 3.
A 43-year-old woman, ex-smoker, with a 9-mm wide-neck superior hypophyseal aneurysm treated with a single PED. A, Lateral internal carotid artery DSA pre-PED. B, Lateral DSA 5 months after PED deployment demonstrates asymptomatic extensive long-segment in-stent stenosis. Clopidogrel and aspirin were continued. C, Lateral DSA 12 months after PED deployment shows marked improvement in the extent as well as the degree of narrowing (30%). Clopidogrel was ceased, but aspirin was to continue.
- Fig 4.
A 62-year-old woman who presented with 2 days of increasing dysarthria, tongue weakness, and mild quadriparesis. A, T2-weighted axial MR image demonstrates a 30-mm aneurysm compressing the medulla and the fourth ventricle. B, Lateral DSA of the vertebrobasilar system shows a fusiform aneurysm of the proximal basilar trunk, incorporating the vertebrobasilar junction and the distal left vertebral artery. Two 2.75 × 18 mm PEDs overlapping in the sac were deployed into the basilar artery and left vertebral artery. Coils were place in the distal right vertebral artery to stop an endoleak. The patient was placed on steroids but, 36 hours after treatment, had worsening of quadriparesis and developed bilateral ophthalmoplegia. MR imaging (not shown) did not completely demonstrate an infarct, and CTA (not shown) demonstrated occlusion of the aneurysm and patency of the PED. The patient was given an additional steroid bolus and recovered to normal health within 3 days. C, Six-month lateral left vertebral DSA demonstrates occlusion of the aneurysm with no stenosis. The coils in the right vertebral artery are visible as artifact. CT at 12 months (not shown) did not show a reduction in the size of the thrombosed aneurysm. Clopidogrel was ceased, and aspirin was continued. D, CTA at 18 months shows complete resorption of the aneurysm and absence of mass effect.
Tables
Size No. 1 PED 2 PED 3 PED Coils >25 mm 7 1 5 1 1 10–25 mm 32 16 11 5 2 <10 mm 18 7 9 2 3 Total 57 24 25 8 6 Aneurysms (n = 57) Berry (n = 46) Fusiform (n = 11) % Occluded at 6 Months >25 mm (n = 7) 3 4 100.00 10–25 mm (n = 32) 27 5 84.40 <10 mm (n = 18) 16 2 78.00 % Occluded at 6 months 89.13 63.64 No Previous Aneurysm Treatment Previous Treatment (Devices Inserted) Prior to PED Treatment PED Only or PED + Coils Coils or Clip Stenta or Stent/Coilsb No. 41 10 6 Occluded at 1 month (n/z) 19/31 6/7 1/4 Occluded at 6 months (n/z) 37/40 8/10 3/6 % Occlusion at 6 months 92.5% 80% 50.0% No. not occluded at 6 months 4 2 3 No. subsequently occluded by 14 months 3
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