Single-session treatment of bilateral, tandem, internal carotid artery aneurysms with pipeline flex with shield technology

Abstract

The treatment of intracranial aneurysms (IA) has been transformed by the development of flow-diversion (FD) devices. Initially, these revolutionary devices were conceived for giant and fusiform aneurysms located on the internal carotid artery (ICA). Technological improvements have expanded their indications. Distal middle cerebral, anterior cerebral artery aneurysms, or even posterior fossa aneurysms can now benefit from this technology. One other category of aneurysms that can be treated is multiple IA’s.
 Multiple IA’s are encountered in approximately one-quarter of patients presenting with subarachnoid haemorrhage. Endovascular management of such cases is complex, requiring different devices and treatment strategies to secure all lesions. FD’s can be successfully employed to reconstruct vessels, which harbour more than one aneurysm, especially multiple ICA lesions. Multiple aneurysms located on both ICA’s are generically known as tandem aneurysms.
 We present the case of a patient with tandem aneurysms located on both intracranial internal carotid arteries that we treated simultaneously with the Pipeline Flex with Shield Technology in one single session. To the best of our knowledge, this is the first case reported in the literature so far.