Safety of the Pipeline Embolization Device in Treatment of Posterior Circulation Aneurysms

Patient 17 was a woman 56 years of age with a 6 × 10 mm (height × neck width) basilar tip aneurysm with rapid growth, measuring 2.5 mm 6 years previously. There was incorporation of the left P1 and, to a lesser extent, the right P1 with a patent left posterior communicating artery. The patient had a history of hypertension with triple medical therapy and depression. A, C, E, and F, Subtracted DSA anteroposterior images of the basilar artery. In view of the very unfavorable dome/neck ratio (0:6), we decided to use the PED as a stent-assist construct in this instance because the device would fill the vessel and markedly narrow the neck without “cutting the corners” as other coiling assist constructs tend to. The PED was placed in the left P1 (native image, B) because the right posterior communicating artery was hypoplastic. Coiling was successful with a small locule and maintenance of the posterior communicating artery on the left (C). The patient remained well with appropriate platelet inhibition. After she re-presented with a stroke, MR imaging (D) depicts a right paramedian pontine infarct at the level of the proximal third of the stent within the basilar artery. Angiography performed the same day (E) shows that the aneurysm is occluded, apart from a small side locule, and there is no in-construct stenosis or thrombosis. Follow-up angiography at 11 months (F) shows that the posterior communicating artery and stent are widely patent. The small right locule is significantly smaller.