case_images: PMC10655097_01
case_images: A 49-year-old woman with a recanalized blood blister-like aneurysm. (A) Digital subtraction angiography revealed a recurrent posterior communicating artery aneurysm with a maximum diameter of 9.3 mm. (B, C) Previously placed LVIS stent and loose coils. (D) Aneurysm achieved near-complete occlusion through pipeline embolization device-assisted coiling. (E-H) Pipeline embolization device covered only the proximal end of the previous LVIS stent. (I, J) A 6-month follow-up computed tomography angiography (CTA) indicated complete occlusion.
case_images: fneur-14-1267258-g0002.jpg
case_images: PMC10655097_01_fneur-14-1267258-g0002.jpg
case_images: F2
case_images: DSA revealed a recurrent aneurysm with a maximum diameter of ~9.3 mm (Figure 2A). The previous LVIS stent and loose coils are shown in Figures 2B, C, respectively. A complete occlusion of the recanalized aneurysm was achieved (Figure 2D). The PED covered only the proximal end of the LVIS stent (Figures 2E, F).
case_images: PMC10655097_02
case_images: A 48-year-old woman has been diagnosed with a recurrent giant aneurysm. (A-C) The aneurysm is located in the posterior communicating artery, with a size of 45.2 x 43.7 mm, as observed in digital subtraction angiography. (A)
   Stenosis of the proximal parent artery was indicated. (B)
   Images showed that the proximal markers of the enterprise were visible in the neck of the aneurysm. (C)
   Aneurysm is not involved in the bifurcation of the internal carotid artery. (D) Balloon angioplasty was performed to address the stenosis of the proximal parent artery. (E) A pipeline embolization device was deployed. (F) Relief of the stenosis. (G-J) The pipeline embolization device was observed to cover only the distal end of the enterprise.
case_images: fneur-14-1267258-g0003.jpg
case_images: PMC10655097_02_fneur-14-1267258-g0003.jpg
case_images: F3
case_images: A 9-month follow-up DSA showed a major recurrence (Figures 3A-C). The stenosis of the proximal parent artery was confirmed (Figure 3A). Proximal markers of the Enterprise were seen in the aneurysmal neck (Figure 3B), and the aneurysm was not involved in the bifurcation of the ICA (Figure 3C). Retreatment of the giant aneurysm was performed with a PED (Medtronic, Minneapolis, Minnesota) of 4.5 mm x 35 mm after balloon angioplasty (Figures 3D-F). The stenosis of the proximal parent artery was relieved (Figure 3F). The PED covered only the distal end of the enterprise stent (Figures 3G-J).
case_images: PMC10655097_03
case_images: A 36-year-old woman has been diagnosed with a recurrent blood blister-like aneurysm. (A) The aneurysm is located in the posterior communicating artery and has dimensions of 2.0 x 2.5 mm, as observed in digital subtraction angiography. (B) To treat the aneurysm, a stent-assisted coiling (LVIS) procedure was performed, achieving near-complete occlusion of the aneurysm. (C, D) A 6-month and 12-month follow-up angiography confirmed that the aneurysm had recanalized. (E, F) Deployment of a pipeline embolization device. (G, H) The 12-month follow-up after retreatment angiography demonstrated complete occlusion of the aneurysm. (I-L) The PED is a pipeline embolization device within the previous LVIS.
case_images: fneur-14-1267258-g0004.jpg
case_images: PMC10655097_03_fneur-14-1267258-g0004.jpg
case_images: F4
case_images: DSA demonstrated a BBA of P-comm, with a size of 2.0 x 2.5 x 3.0 mm (Figure 4A). Stent-assisted coiling was performed (LVIS; MicroVention, 4.0 x 20 mm; Figure 4B), and four coils were used. A 6-month follow-up angiography after LVIS stent implantation confirmed recanalization of the aneurysm (Figure 4C), and a 12-month follow-up angiography revealed aggravation of recanalization (Figure 4D). The BBA was then retreated with a PED (Medtronic, Minneapolis, Minnesota, 3.0 mm x 16 mm; Figures 4E, F). A 12-month follow-up after retreatment showed complete occlusion (Figures 4G, H). The PED was implanted within the LVIS stent (Figures 4I-L).
case_images: PMC10655097_04
case_images: A 56-year-old woman has a recurrent giant aneurysm, specifically in the posterior communicating artery. (A-C) Digital subtraction angiography revealed the size of the aneurysm to be 24.3 x 25.8 mm. It has been confirmed that the patient has bilateral patent right fetal PCAs (posterior cerebral arteries).  indicates the presence of right PCA under injection of the right internal common artery.  indicates the absence of right PCA under injection of the right vertebral artery. (D) Implantation of pipeline embolization device.  indicates the presence of right PCA under injection of the right internal common artery. (E-H) The pipeline embolization device covers the proximal end of the previous Solitaire device. (I-Q) The -month, 10-month, and 16-month follow-up angiographies are shown. (J, M, P) Gradual occlusion of the right posterior communicating artery. (K, N, Q) Gradual opening of P1 segment of right PCA (K, N, Q).  indicates right PCA under injection of the right internal common artery;  indicates P1 segment of right PCA under injection of the right vertebral artery.
case_images: fneur-14-1267258-g0005.jpg
case_images: PMC10655097_04_fneur-14-1267258-g0005.jpg
case_images: F5
case_images: A 3-month follow-up DSA indicated a major recurrence (Figures 5A-C). Bilateral fetal PCAs were confirmed, and the right PCA was shown in Figures 5B, C. Retreatment of the giant aneurysm was performed with a PED (Medtronic, Minneapolis, Minnesota) of 4.5 mm x 35 mm and six coils after balloon angioplasty (Figure 5D). The PED covered only the proximal end of the solitaire device (Figures 5E-H). A 4-month (Figures 5I-K), 10-month (Figures 5L-N), and 16-month (Figures 5O-Q) follow-up angiographies after PED implantation were shown. Injection into the right internal carotid artery demonstrated: (1) gradual healing of the recanalized aneurysm and (2) occlusion of the right P-comm (Figures 5M, P). Injection into the right vert artery demonstrated the reopening of the P1 segment of the right posterior cerebral artery (Figures 5N, Q). A 4th-month follow-up DSA of patient #4 showed that the residual contrast agent in the tumor neck was more obvious than immediately after the PED implantation (Figures 5D, I). A 10-month follow-up DSA after PED implantation showed that the aneurysm neck gradually healed (Figure 5L). After stopping aspirin, DSA showed further healing of the aneurysm neck at 16 months (Figure 5O).