Pipeline embolization device for the treatment of a traumatic intracranial aneurysm in a child

Trivelato, Felipe Padovani; Rezende, Marco Túlio Salles; Fonseca, Luiz Venâncio; Bonadio, Lucas Eduardo; Ulhôa, Alexandre Cordeiro; Abud, Daniel Giansante

doi:10.1007/s00381-016-3334-5

Cited by 12 publications

(6 citation statements)

References 15 publications

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“…Dissecting aneurysms are generally secondary to trauma, infection, or congenital diseases. [ 13 , 44 ] In our cases, there were no cases secondary to congenital diseases, vasculitis, collagen, or hematologic diseases, such as sickle cell anemia. Nevertheless, according to literature review, some of these diseases represent between 10 and 20% of cases.…”

Section: Discussionmentioning

confidence: 63%

“…Even today, there are not many cases of PIAs in the world treated with FDs, nevertheless, the experience continues to grow. [4,9,13,19,21,27,[44][45][46][47] According to the literature review, it should be stated that the first case of a child treated with a pipeline device (PED) was reported in 2009 by Lylyk et al, along with other adult patients, but without providing specific details. [27] At early 2017, Barburoglu and Arat reported a successful use of FDs on five PIAs and in their review of reports around the world, they gathered information about 15 successful PIAs treatment.…”

Section: Discussionmentioning

confidence: 99%

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Intracranial aneurysms in pediatric population treated with flow diverters: A single-center experience

Santos-Franco¹,

Cruz-Argüelles²,

Agustin-Aguilar³

et al. 2022

Surgical Neurology International

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Background: Pediatric intracranial aneurysms (PIAs) are uncommon. Flow diverters (FDs) have shown to be effective on treatment of selected aneurysms. Methods: We describe 10 cases of PIAs treated with FDs at one medical center in Mexico, from April 2015 to April 2020. Results: Out of 230 patients treated with FDs, 10 (4.3%) were pediatric. Average age was 9.4 years old (R: 6–15). Two patients (20%) had subarachnoid hemorrhage, 3 had epilepsy (30%), 3 (30%) had clinical signs of cranial nerve compression, and 4 (40%) had only headache. Two patients were in 1a grade of Hunt and Kosnik scale. Out of the nonruptured aneurysms, 7 (70%) were in 15 points of Glasgow Coma Scale and 1 patient (10%) was in 13 points. Treatment was performed without complications; nevertheless, appropriate distal deployment was not achieved in one case. At discharge, nine patients had 5 points of Glasgow Outcome Scale. All patients underwent computed tomography angiography or digital subtraction angiography at 1, 3, 6, and 12 months, 2 patients (20%) had a 2-year follow-up, and 3 patients (30%) had a 3-year follow-up. According to Kamran grading scale, 9 patients (90%) were classified as Grade 4 and 1 patient (10%) as Grade 3. Conclusion: Even though it is a small series, as this is an uncommon disease, we may suggest that FDs are useful to treat properly selected PIAs. Our study has consecutive imaging assessment at least a year of follow-up in which aneurysm stable occlusion was observed in 90% of patients.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Intracranial aneurysms in pediatric population treated with flow diverters: A single-center experience

Santos-Franco¹,

Cruz-Argüelles²,

Agustin-Aguilar³

et al. 2022

Surgical Neurology International

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“…To date, there have been only 52 reported cases of pediatric aneurysms treated with PEDs. 20,21 Of those, only 19 cases described treatment of pediatric pseudoaneurysms, 9,20,[22][23][24][25][26][27][28][29][30][31] with only 7 describing treatment of pseudoaneurysms presenting with hemorrhage (Table 3). 23,24,27,28,30 Colby et al 9 described treatment of a 9-month-old patient with a large middle cerebral artery pseudoaneurysm secondary to resection of an intrinsic brain tumor.…”

Section: Discussionmentioning

confidence: 99%

Initial experience with Pipeline embolization of intracranial pseudoaneurysms in pediatric patients

Budohoski

Thakrar

Voronovich

et al. 2022

Journal of Neurosurgery: Pediatrics

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OBJECTIVE Flow-diverting devices have been used successfully for the treatment of complex intracranial vascular injuries in adults, but the role of these devices in treating iatrogenic and traumatic intracranial vascular injuries in children remains unclear. The authors present their experience using the Pipeline embolization device (PED) for treating intracranial pseudoaneurysms in children. METHODS This single-center retrospective cohort study included pediatric patients with traumatic and iatrogenic injuries to the intracranial vasculature that were treated with the PED between 2015 and 2021. Demographic data, indications for treatment, the number and sizes of PEDs used, follow-up imaging, and clinical outcomes were analyzed. RESULTS Six patients with a median age of 12 years (range 7–16 years) underwent PED placement to treat intracranial pseudoaneurysms. There were 3 patients with hemorrhagic presentation, 2 with ischemia, and 1 in whom a growing pseudoaneurysm was found on angiography. Injured vessels included the anterior cerebral artery (n = 2), the supraclinoid internal carotid artery (ICA, n = 2), the cavernous ICA (n = 1), and the distal cervical ICA (n = 1). All 6 pseudoaneurysms were successfully treated with PED deployment. One patient required re-treatment with a second PED within a week because of concern for a growing pseudoaneurysm. One patient experienced parent vessel occlusion without neurological sequelae. CONCLUSIONS Use of the PED is feasible for the management of iatrogenic and traumatic pseudoaneurysms of the intracranial vasculature in children, even in the setting of hemorrhagic presentation.

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“…2 Post-traumatic intracranial false aneurysms occurrence after a head injury have different localizations than nontraumatic ones. 10 Association between a false aneurysm and arachnoid cyst may be advantageous. One study suggests potential links with an ipsilateral lesion in case of associa-tion.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, only one case of a child aneurysm treated by a flow diverter stent has been published. 10 Stents have hemodynamic but also.…”

Section: Discussionmentioning

confidence: 99%

Vasodilator-Stimulated Phosphoprotein to Monitor Clopidogrel Posology in a 7-Year-Old Child Stented for a Post-Traumatic Intracranial Internal Carotid Artery Aneurysm

Hess

Zhu

Miguel

et al. 2021

Journal of Pediatric Neurology

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Many pediatric medical protocols or drug posology like biantiplatelet therapy are extrapolated from adult care. This association could be indicated in specific pediatric situations such as ischemic stroke, some cardiac conditions, or to control post stent thrombosis/stenosis. If acetylsalicylic acid is commonly used, few data are available about optimal management of clopidogrel in children. We describe the case of a 7-year-old girl admitted to pediatric intensive care unit who undergoes a transitory hemiparesis after a bicycle accident. Brain magnetic resonance imaging reveals a subarachnoid hemorrhage and a wide right Sylvian arachnoid cyst. Hemorrhage predominated at the level of the optochiasmatic cistern, close to the right internal carotid artery. At the same level, angiography revealed a small aneurysm of the internal carotid artery supposed to be a postfalse traumatic aneurysm. The deployment treated this aneurysm of a flow diverter. The treatment was performed under continuous systemic heparin therapy associated with intravenous acetylsalicylic acid, and Clopidogrel was administered immediately after the procedure. An oral bi antiplatelet treatment was initiated the day 2 with acetylsalicylic acid and clopidogrel (1 mg/kg/day). To monitor clopidogrel posology, a vasodilator-stimulated phosphoprotein [VASP]) was performed. The final VASP assay result was 20% for a clopidogrel posology at 0.5 mg/kg/day. Blood pressure and neurological examination were normal during all the hospitalization. VASP assay can be used in children to define the optimal posology of clopidogrel. Further studies are required to determine an optimal initial posology.

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Pipeline embolization device for the treatment of a traumatic intracranial aneurysm in a child

Cited by 12 publications

References 15 publications

Intracranial aneurysms in pediatric population treated with flow diverters: A single-center experience

Intracranial aneurysms in pediatric population treated with flow diverters: A single-center experience

Initial experience with Pipeline embolization of intracranial pseudoaneurysms in pediatric patients

Vasodilator-Stimulated Phosphoprotein to Monitor Clopidogrel Posology in a 7-Year-Old Child Stented for a Post-Traumatic Intracranial Internal Carotid Artery Aneurysm

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