Vertebral Artery Aneurysm: Ruptured Dissecting Aneurysm, Implantation of Telescoping p48_HPC Flow Diverter Stents under Antiaggregation with ASA Only

  • Frances Colgan
  • Marta Aguilar Pérez
  • Victoria Hellstern
  • Matthias Reinhard
  • Stefan Krämer
  • Hansjörg Bäzner
  • Oliver Ganslandt
  • Hans HenkesEmail author
Living reference work entry


A 66-year-old male patient sustained blunt trauma to the head and neck during a seizure following alcohol withdrawal. Two days later, he developed massive subarachnoid hemorrhage (SAH) and was found to have a ruptured left vertebral artery dissecting aneurysm (V4 segment). He was successfully treated with the insertion of telescoping p48_HPC flow diverter stents under monoantiplatelet therapy and made a full recovery. Flow diverter stents offer a possibility for effective treatment in intracranial hemorrhage in the absence of other clinically viable options or as an alternative to parent vessel occlusion. The usage of flow diverter stents with reduced thrombogenicity due to hydrophilic surface coating is the main topic of this chapter.


Vertebral artery Dissecting aneurysm Subarachnoid hemorrhage SAH p48_HPC Flow diversion Hydrophilic coating ASA only 


  1. Ali MS, Amenta PS, Starke RM, Jabbour PM, Gonzalez LF, Tjoumakaris SI, Flanders AE, Rosenwasser RH, Dumont AS. Intracranial vertebral artery dissections: evolving perspectives. Interv Neuroradiol. 2012;18(4):469–83. Scholar
  2. Becske T, Brinjikji W, Potts MB, Kallmes DF, Shapiro M, Moran CJ, Levy EI, McDougall CG, Szikora I, Lanzino G, Woo HH, Lopes DK, Siddiqui AH, Albuquerque FC, Fiorella DJ, Saatci I, Cekirge SH, Berez AL, Cher DJ, Berentei Z, Marosfoi M, Nelson PK. Long-term clinical and angiographic outcomes following pipeline embolization device treatment of complex internal carotid artery aneurysms: five-year results of the pipeline for uncoilable or failed aneurysms trial. Neurosurgery. 2017;80(1):40–8.
  3. Briganti F, Leone G, Marseglia M, Mariniello G, Caranci F, Brunetti A, Maiuri F. Endovascular treatment of cerebral aneurysms using flow-diverter devices: a systematic review. Neuroradiol J. 2015;28(4):365–75. Scholar
  4. Chiu AH, Ramesh R, Wenderoth J, Davies M, Cheung A. Use of aspirin as sole oral antiplatelet therapy in acute flow diversion for ruptured dissecting aneurysms. J Neurointerv Surg. 2017;9(5):e18. Scholar
  5. Cohen JE, Gomori JM, Moscovici S, Bala M, Itshayek E. The use of flow diverter stents in the management of traumatic vertebral artery dissections. J Clin Neurosci. 2013;20(5):731–4. Scholar
  6. Cohen JE, Gomori JM, Rajz G, Rosenthal G, El Hassan HA, Moscovici S, Itshayek E. Vertebral artery pseudoaneurysms secondary to blunt trauma: endovascular management by means of neurostents and flow diverters. J Clin Neurosci. 2016;32:77–82. Scholar
  7. Ducruet AF, Crowley RW, Albuquerque FC, McDougall CG. Reconstructive endovascular treatment of a ruptured vertebral artery dissecting aneurysm using the pipeline embolization device. J Neurointerv Surg. 2013;5(4):e20. Scholar
  8. Edwards NJ, Jones WH, Sanzgiri A, Corona J, Dannenbaum M, Chen PR. Antiplatelet therapy for the prevention of peri-coiling thromboembolism in high-risk patients with ruptured intracranial aneurysms. J Neurosurg. 2017;127(6):1326–32. Scholar
  9. Fusco MR, Harrigan MR. Cerebrovascular dissections: a review. Part II: blunt cerebrovascular injury. Neurosurgery. 2011;68(2):517–30; discussion 530. Scholar
  10. Girdhar G, Li J, Kostousov L, Wainwright J, Chandler WL. In-vitro thrombogenicity assessment of flow diversion and aneurysm bridging devices. J Thromb Thrombolysis. 2015;40(4):437–43. Scholar
  11. Harrigan MR, Hadley MN, Dhall SS, Walters BC, Aarabi B, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Theodore N. Management of vertebral artery injuries following non-penetrating cervical trauma. Neurosurgery. 2013;72(Suppl 2):234–43. Scholar
  12. Hernández-Durán S, Ogilvy CS. Clinical outcomes of patients with vertebral artery dissection treated endovascularly: a meta-analysis. Neurosurg Rev. 2014;37(4):569–77. Scholar
  13. Huang YC, Chen YF, Wang YH, Tu YK, Jeng JS, Liu HM. Cervicocranial arterial dissection: experience of 73 patients in a single center. Surg Neurol. 2009;72(Suppl 2):S20–7; discussion S27. Scholar
  14. Kallmes DF, Hanel R, Lopes D, Boccardi E, Bonafé A, Cekirge S, Fiorella D, Jabbour P, Levy E, McDougall C, Siddiqui A, Szikora I, Woo H, Albuquerque F, Bozorgchami H, Dashti SR, Delgado Almandoz JE, Kelly ME, Turner R 4th, Woodward BK, Brinjikji W, Lanzino G, Lylyk P. International retrospective study of the pipeline embolization device: a multicenter aneurysm treatment study. AJNR Am J Neuroradiol. 2015;36(1):108–15. Scholar
  15. Kallmes DF, Brinjikji W, Cekirge S, Fiorella D, Hanel RA, Jabbour P, Lopes D, Lylyk P, McDougall CG, Siddiqui A. Safety and efficacy of the pipeline embolization device for treatment of intracranial aneurysms: a pooled analysis of 3 large studies. J Neurosurg. 2017;127(4):775–80. Scholar
  16. Majidi S, Hassan AE, Adil MM, Jadhav V, Qureshi AI. Incidence and outcome of vertebral artery dissection in trauma setting: analysis of national trauma data base. Neurocrit Care. 2014;21(2):253–8. Scholar
  17. Marosfoi M, Clarencon F, Langan ET, King RM, Brooks OW, Tamura T, Wainwright JM, Gounis MJ, Vedantham S, Puri AS. Acute thrombus formation on phosphorilcholine surface modified flow diverters. J Neurointerv Surg. 2018;10(4):406–11. Scholar
  18. Martínez-Galdámez M, Lamin SM, Lagios KG, Liebig T, Ciceri EF, Chapot R, Stockx L, Chavda S, Kabbasch C, Farago G, Nordmeyer H, Boulanger T, Piano M, Boccardi EP. Periprocedural outcomes and early safety with the use of the pipeline flex embolization device with shield technology for unruptured intracranial aneurysms: preliminary results from a prospective clinical study. J Neurointerv Surg. 2017;9(8):772–6. Scholar
  19. Matsuda Y, Jang DK, Chung J, Wainwright JM, Lopes D. Preliminary outcomes of single antiplatelet therapy for surface-modified flow diverters in an animal model: analysis of neointimal development and thrombus formation using OCT. J Neurointerv Surg. 2018. pii: neurintsurg-2018-013935.
  20. McAuliffe W, Wenderoth JD. Immediate and midterm results following treatment of recently ruptured intracranial aneurysms with the pipeline embolization device. AJNR Am J Neuroradiol. 2012;33(3):487–93. Scholar
  21. Medel R, Starke RM, Valle-Giler EP, Martin-Schild S, El Khoury R, Dumont AS. Diagnosis and treatment of arterial dissections. Curr Neurol Neurosci Rep. 2014;14(1):419. Scholar
  22. Mohan IV. Current optimal assessment and management of carotid and vertebral spontaneous and traumatic dissection. Angiology. 2014;65(4):274–83. Scholar
  23. Narata AP, Yilmaz H, Schaller K, Lovblad KO, Pereira VM. Flow-diverting stent for ruptured intracranial dissecting aneurysm of vertebral artery. Neurosurgery. 2012;70(4):982–8; discussion 988–9. Scholar
  24. Orlov K, Kislitsin D, Strelnikov N, Berestov V, Gorbatykh A, Shayakhmetov T, Seleznev P, Tasenko A. Experience using pipeline embolization device with shield technology in a patient lacking a full postoperative dual antiplatelet therapy regimen. Interv Neuroradiol. 2018;24(3):270–3. Scholar
  25. Perez P, Lukaszewicz AC, Lenck S, Nizard R, Drouet L, Payen D. Platelet activation and aggregation after aneurysmal subarachnoid hemorrhage. BMC Neurol. 2018;18(1):57. Scholar
  26. Saber H, Kherallah RY, Hadied MO, Kazemlou S, Chamiraju P, Narayanan S. Antiplatelet therapy and the risk of ischemic and hemorrhagic complications associated with pipeline embolization of cerebral aneurysms: a systematic review and pooled analysis. J Neurointerv Surg. 2018. pii: neurintsurg-2018-014082.
  27. Yeung TW, Lai V, Lau HY, Poon WL, Tan CB, Wong YC. Long-term outcome of endovascular reconstruction with the pipeline embolization device in the management of unruptured dissecting aneurysms of the intracranial vertebral artery. J Neurosurg. 2012;116(4):882–7. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Frances Colgan
    • 1
  • Marta Aguilar Pérez
    • 5
  • Victoria Hellstern
    • 5
  • Matthias Reinhard
    • 2
  • Stefan Krämer
    • 3
  • Hansjörg Bäzner
    • 4
  • Oliver Ganslandt
    • 6
  • Hans Henkes
    • 5
    Email author
  1. 1.Department of RadiologyUniversity of Otago, Christchurch HospitalChristchurchNew Zealand
  2. 2.Klinik für Neurologie und klinische NeurophysiologieKlinikum EsslingenEsslingenGermany
  3. 3.Klinik für Radiologie und NuklearmedizinKlinikum EsslingenEsslingenGermany
  4. 4.Neurologische Klinik, NeurozentrumKlinikum StuttgartStuttgartGermany
  5. 5.Neuroradiologische Klinik, NeurozentrumKlinikum StuttgartStuttgartGermany
  6. 6.Neurochirurgische Klinik, NeurozentrumKlinikum StuttgartStuttgartGermany

Personalised recommendations