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Extracranial-intracranial high-flow bypass as a rescue therapy for incomplete cerebral aneurysm occlusion after flow diversion: A case report
BACKGROUND: Excellent treatment outcomes using a pipeline embolization device (PED) have been reported. However, several limitations exist. For example, patients must receive antiplatelet therapy for at least several months, and few alternative treatments exist except for inserting additional flow d...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Scientific Scholar
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7911044/ https://www.ncbi.nlm.nih.gov/pubmed/33654560 http://dx.doi.org/10.25259/SNI_836_2020 |
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author | Kamide, Tomoya Misaki, Kouichi Uno, Takehiro Yoshikawa, Akifumi Uchiyama, Naoyuki Nakada, Mitsutoshi |
author_facet | Kamide, Tomoya Misaki, Kouichi Uno, Takehiro Yoshikawa, Akifumi Uchiyama, Naoyuki Nakada, Mitsutoshi |
author_sort | Kamide, Tomoya |
collection | PubMed |
description | BACKGROUND: Excellent treatment outcomes using a pipeline embolization device (PED) have been reported. However, several limitations exist. For example, patients must receive antiplatelet therapy for at least several months, and few alternative treatments exist except for inserting additional flow diverter stents in cases where aneurysm obliteration is not obtained. CASE DESCRIPTION: A 67-year-old female suffered from an asymptomatic large aneurysm of the left paraclinoid internal carotid artery (ICA). She underwent endovascular coil embolization, but coil compaction was confirmed at 2-year follow-up. A PED was inserted as an additional treatment. Unfortunately, the patient was required to discontinue antiplatelet therapy to undergo orthopedic surgery for her severe osteoarthritis of the knee. However, surveillance imaging performed 2 years after insertion of the PED revealed persistent filling into the aneurysm, and we could not stop the antiplatelet therapy to proceed with orthopedic surgery. Therefore, we performed ICA trapping with extracranial-intracranial high-flow bypass to cease antiplatelet therapy promptly. Antiplatelet therapy was completed 3 months after the rescue surgery, and the patient underwent orthopedic surgery. CONCLUSION: The authors describe a case of failure of complete obliteration after treatment using a PED, which required cessation of antiplatelet therapy to receive orthopedic surgery. Although safety and efficacy of PED treatment have been reported, we must consider the possibility of other diseases requiring discontinuation of antiplatelet therapy after PED embolization. |
format | Online Article Text |
id | pubmed-7911044 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Scientific Scholar |
record_format | MEDLINE/PubMed |
spelling | pubmed-79110442021-03-01 Extracranial-intracranial high-flow bypass as a rescue therapy for incomplete cerebral aneurysm occlusion after flow diversion: A case report Kamide, Tomoya Misaki, Kouichi Uno, Takehiro Yoshikawa, Akifumi Uchiyama, Naoyuki Nakada, Mitsutoshi Surg Neurol Int Case Report BACKGROUND: Excellent treatment outcomes using a pipeline embolization device (PED) have been reported. However, several limitations exist. For example, patients must receive antiplatelet therapy for at least several months, and few alternative treatments exist except for inserting additional flow diverter stents in cases where aneurysm obliteration is not obtained. CASE DESCRIPTION: A 67-year-old female suffered from an asymptomatic large aneurysm of the left paraclinoid internal carotid artery (ICA). She underwent endovascular coil embolization, but coil compaction was confirmed at 2-year follow-up. A PED was inserted as an additional treatment. Unfortunately, the patient was required to discontinue antiplatelet therapy to undergo orthopedic surgery for her severe osteoarthritis of the knee. However, surveillance imaging performed 2 years after insertion of the PED revealed persistent filling into the aneurysm, and we could not stop the antiplatelet therapy to proceed with orthopedic surgery. Therefore, we performed ICA trapping with extracranial-intracranial high-flow bypass to cease antiplatelet therapy promptly. Antiplatelet therapy was completed 3 months after the rescue surgery, and the patient underwent orthopedic surgery. CONCLUSION: The authors describe a case of failure of complete obliteration after treatment using a PED, which required cessation of antiplatelet therapy to receive orthopedic surgery. Although safety and efficacy of PED treatment have been reported, we must consider the possibility of other diseases requiring discontinuation of antiplatelet therapy after PED embolization. Scientific Scholar 2021-02-17 /pmc/articles/PMC7911044/ /pubmed/33654560 http://dx.doi.org/10.25259/SNI_836_2020 Text en Copyright: © 2020 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Case Report Kamide, Tomoya Misaki, Kouichi Uno, Takehiro Yoshikawa, Akifumi Uchiyama, Naoyuki Nakada, Mitsutoshi Extracranial-intracranial high-flow bypass as a rescue therapy for incomplete cerebral aneurysm occlusion after flow diversion: A case report |
title | Extracranial-intracranial high-flow bypass as a rescue therapy for incomplete cerebral aneurysm occlusion after flow diversion: A case report |
title_full | Extracranial-intracranial high-flow bypass as a rescue therapy for incomplete cerebral aneurysm occlusion after flow diversion: A case report |
title_fullStr | Extracranial-intracranial high-flow bypass as a rescue therapy for incomplete cerebral aneurysm occlusion after flow diversion: A case report |
title_full_unstemmed | Extracranial-intracranial high-flow bypass as a rescue therapy for incomplete cerebral aneurysm occlusion after flow diversion: A case report |
title_short | Extracranial-intracranial high-flow bypass as a rescue therapy for incomplete cerebral aneurysm occlusion after flow diversion: A case report |
title_sort | extracranial-intracranial high-flow bypass as a rescue therapy for incomplete cerebral aneurysm occlusion after flow diversion: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7911044/ https://www.ncbi.nlm.nih.gov/pubmed/33654560 http://dx.doi.org/10.25259/SNI_836_2020 |
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