Abstract 262: Pipeline embolization, an Endovascular Therapeutic Option for Complex Rupture Serpentine Fusiform Aneurysm

Introduction Serpentine aneurysms are a subtype of partially thrombosed aneurysms characterized by an eccentrically located, tortuous intra‐aneurysmal vascular channel. Their large size, complex neck morphology, and the frequent involvement of the outflow tract in supplying normal brain parenchyma present significant technical challenges for treatment. Materials/Methods The patient was evaluated in routine clinical practice. Results A 47‐year‐old woman with a known diagnosis of left posterior cerebral artery fusiform aneurysm extending from P1 to P2 segment presented to the emergency department for sudden onset dysarthria and a month history of progressive right hemiparesis. The aneurysm had previously been diagnosed seven years prior via cerebral angiography, but the patient declined any intervention. Neurologic exam was pertinent for left mydriasis, and right hemiparesis. CTH showed a hyperdensity in left midbrain suggestive of an acute hemorrhage, CTA brain showed redemonstration of the aneurysm, stable in size at 1.7x1.5x1.7cm, and MRI brain showed thrombosis of the aneurysm with hyperacute blood products. Due to the complexity of aneurysm, the decision was made to treat it endovascularly. The patient was preoperatively administered oral antiplatelet therapy consisting of aspirin 100 mg and ticagrelor 180 mg, followed by intravenous heparin during the procedure to maintain an activated clotting time of 250‐300 seconds. Under general anesthesia, radial artery access was obtained, and the right vertebral artery was catheterized using a Benchmark 81 guide catheter in combination with a 5‐French Penumbra Select catheter. A Phenom 21 microcatheter was then advanced over a microwire to the P3 segment of the left posterior cerebral artery, through which two Pipeline embolization devices were successfully deployed across the P1 and P2 segments, achieving flow diversion of the serpentine fusiform aneurysm. The patient remained hospitalized for 14 days and was discharged home with a mRS of 2. Conclusion This case demonstrates a successful approach to treating a symptomatic serpentine fusiform aneurysm endovascularly with pipeline embolization. Previously reported cases have mainly been treated with neurosurgical approaches and endovascularly with coiling. Flow‐directing stents have demonstrated safety and efficacy in treating simple fusiform aneurysms. Utilizing this treatment approach has the benefit of allowing continued perfusion to the area supplied by the aneurysm compared with occlusive methods. Additionally, endovascular treatment, as opposed to neurosurgical, allows a faster recovery and decreased complications. image