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Case report
Rupture of giant vertebrobasilar aneurysm following flow diversion: mechanical stretch as a potential mechanism for early aneurysm rupture
  1. Benjamin Fox1,
  2. William Edward Humphries2,
  3. Vinodh T Doss3,
  4. Daniel Hoit4,
  5. Lucas Elijovich5,
  6. Adam S Arthur6
  1. 1Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  2. 2Department of Neurosurgery, UTHSC, Semmes-Murphey, Memphis, Tennessee, USA
  3. 3Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  4. 4Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, USA
  5. 5Semmes-Murphey Clinic, Memphis, Tennessee, USA
  6. 6Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  1. Correspondence to Dr Adam S Arthur, aarthur{at}semmes-murphey.com

Abstract

A patient with a giant symptomatic vertebrobasilar aneurysm was treated by endoscopic third ventriculostomy for obstructive hydrocephalus followed by treatment of the aneurysm by flow diversion using a Pipeline Embolization Device. After an uneventful procedure and initial periprocedural period, the patient experienced an unexpected fatal subarachnoid hemorrhage 1 week later. Autopsy demonstrated extensive subarachnoid hemorrhage and aneurysm rupture (linear whole wall rupture). The patent Pipeline Embolization Device was in its intended location, as was the persistent coil occlusion of the distal left vertebral artery. The aneurysm appeared to rupture in a linear manner and contained a thick large expansile clot that seemed to disrupt or rupture the thin aneurysm wall directly opposite the basilar artery/Pipeline Embolization Device. We feel the pattern of aneurysm rupture in our patient supports the idea that the combination of flow diversion and the resulting growing intra-aneurysmal thrombus can create a mechanical force with the potential to cause aneurysm rupture.

  • Aneurysm
  • Flow Diverter
  • Hemorrhage
  • Complication
  • Hydrocephalus

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