Use of Pipeline Flex flow diverter in the treatment of an internal carotid artery Dissection: A case report

Abstract

IntroductionAlthough relatively rare, subarachnoid hemorrhage (SAH) may be caused by a ruptured internal carotid artery (ICA) dissection. Given the tortuous nature of the ICA, flexible flow diverting devices may be more promising in the management of ICA dissections than stent-graft devices. Here we demonstrate the successful application of a Pipeline Flex Flow Diverter. Case DescriptionA 42 year old female with a past medical history of migraines and anxiety presented to ED after several days of left-sided headaches, facial, and upper extremity numbness and tingling. Head CT demonstrated small SAH along the high left convexity tracking along the sulcus. CTA of head and neck demonstrated left ICA dissection from the distal cervical segment to the intracranial communicating segment with partial healing at the cavernous and petrous segments. She was initially started on aspirin for treatment of her dissection. Given that her SAH occurred 7 days prior to admission, it was not aggressively managed. She underwent Pipeline Flex Flow Diverter and Wingspan stenting of her left suprasellar and distal cervical ICA. She was then placed on Plavix and continued on aspirin for 6 months. At 7 month follow-up, she was asymptomatic and diagnostic cerebral angiogram demonstrated resolution of dissecting left suprasellar and cervical aneurysms with Pipeline stent construct. ConclusionThe Pipeline Flex Flow Diverter is flexible enough to comfortably navigate the tortuous track of the ICA. Although its use in the management of ICA dissection has not been extensively reported, it may prove to be a valuable treatment modality.