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Case Report: Pipeline embolization device induced collateral channels in elective flow diversion treatment

机译:病例报告:管道栓塞装置诱发侧支通道选择性分流治疗

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摘要

The pipeline embolization device (PED) is a well recognized treatment for intracranial aneurysms. However, uncertainty remains regarding its effects on flow alteration, which is particularly highlighted by persistently perfused aneurysmal remnants and non-regressing, non-perfused aneurysmal masses. Here we present a 68-year-old woman with an incidental giant fusiform right paraophthalmic aneurysm electively treated with a PED. After lowering her antiplatelet therapy to promote aneurysm thrombosis, she was found to have a progressively enlarging perfused aneurysmal remnant. Angiography revealed PED occlusion, but curiously the development of a peri-construct collateral channel which feeds the aneurysmal remnant, and gives rise to distal branches and contributes to middle cerebral artery flow. The large ‘thrombosed’ aneurysmal mass showed tiny internal vessels on cone beam CT angiography as well as florid enhancement on MRI, further confirming that apparently thrombosed remnants are biologically active and may be remodeled depending on flow demand.
机译:管道栓塞装置(PED)是颅内动脉瘤的公认疗法。然而,关于其对血流改变的影响仍存在不确定性,尤其是持续灌注的动脉瘤残留物和非消退,非灌注的动脉瘤肿块。在这里,我们介绍了一位68岁的女性,患有偶然性的巨大梭形右眼旁动脉瘤,接受了PED选择性治疗。在降低抗血小板治疗以促进动脉瘤血栓形成后,发现她的灌注动脉瘤残留物逐渐增多。血管造影显示PED闭塞,但奇怪的是,周围结构的侧支通道发展为动脉瘤残余供血,并产生远端分支并有助于大脑中动脉流动。较大的“血栓形成”的动脉瘤肿块在锥形束CT血管造影上显示出微小的内部血管,并在MRI上表现出花状增强,进一步证实了血栓形成的残留物具有明显的生物活性,并且可以根据血流需求进行重塑。

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