The p48_HPC antithrombogenic flow diverter: initial human experience using single antiplatelet therapy

Figures

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  Figure 1.. Angiographic images of each of the patients’ aneurysms. (a) Patient 1. (b) Patient 2. (c) Patient 3. (d) Patient 4. (e) Patient 5.

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  Figure 2.. Patient 2. (a) This patient presented in 2016 with acute subarachnoid haemorrhage that was thought to be secondary to a ruptured right posterior communicating artery aneurysm. (b) In addition to the culprit aneurysm, three other aneurysms were identified, including a left pericallosal aneurysm. (c, d) A p48_HPC was implanted in the callosomarginal artery, covering the origin of the pericallosal artery. (e) Minimal opacification of the aneurysm neck was seen on the 3-month follow-up angiogram. (f) On delayed follow-up, the aneurysm was completely occluded and the covered pericallosal artery was reduced in calibre but remained patent with anterograde flow.

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  Figure 3.. Patient 4. (a, b) This patient was undergoing investigations for a headache and was found to have a partially thrombosed aneurysm arising from an M2 branch of the middle cerebral artery on the right side. This was thought to be dissecting in nature, and after discussion among the multidisciplinary team, treatment with flow diversion was offered. (c) After implantation of the p48_HPC, significant stagnation of contrast could be seen within the aneurysm. No intraoperative complications occurred, and the patient remained at her baseline neurological status. Two weeks postoperatively the patient returned to our clinic with a severe headache that was nonresponsive to standard analgesia. (d) Computed tomography imaging revealed a localised haematoma within the right Sylvian fissure. The patient was managed conservatively. (e, f) Delayed angiography showed complete exclusion of the aneurysm from the circulation.