Article Figures & Data
Figures
- Fig 1.
Perforator infarction following PED placement and arterial narrowing of the covered artery on a 12-month follow-up angiogram. A, Anteroposterior view shows the dissecting aneurysm of the left proximal M1 segment. B, Anteroposterior view after PED placement shows absence of filling of the aneurysm and slow flow within the A1 segment. The acquisition was performed with the same parameters but in a later phase to see the A1 segment. C, Single PED placement within the left M1 segment results in contrast stagnation within the aneurysm sac. D and E, DWI and FLAIR sequences performed 2 days later because of transient right brachiofacial hemiparesis demonstrate basal ganglial infarction. F, Twelve-month follow-up angiogram shows the ostial narrowing of the covered collateral branches (arrow).
- Fig 2.
Slow flow within MCA side branch. A, Left MCA aneurysm treated with a PED covering the prefrontal branch. B and C, Slow flow within the covered side branch (arrows). D and E, MR imaging performed on day 1 after the procedure shows acute left anterior MCA infarct.
- Fig 3.
Imaging findings in a patient presenting with cerebral reperfusion syndrome. The patient was treated for a large left carotid cavernous aneurysm with the implantation of 2 overlapped PEDs (A). Seven hours after the procedure, the patient had severe headache and mild aphasia. B and C, FLAIR images show leptomeningeal hyperintensities in the left hemisphere (arrows) without evidence of hemorrhage on T2 gradient-echo (C). D, FLAIR performed 24 hours after the procedure shows complete reversibility of leptomeningeal hyperintensities.
Tables
Characteristics Value % Patients 59 Age (mean, yr) 53.7 Female sex 46 78 Aneurysms 66 Morphology Saccular 44 66.7 Dissecting 16 24.2 Blister 2 3 Fusiform 4 6.1 Size (mean, mm) 10.7 Size (maximum diameter) <10 mm (small) 38 57.6 >10–25 mm (large) 23 34.8 >25 mm (giant) 5 7.6 Neck ≥4 mm 50 75.8 Dome-to-neck ratio <2 36 54.5 Location Anterior circulation 54 81.8 CCA 25 37.9 COA 16 24.2 MCA 7 10.6 ACA 2 3 PcomA 4 6.1 Posterior circulation 12 18.2 BA 2 3 VA 7 10.7 PCA 2 3 PICA 1 1.5 Note:—CCA indicates cavernous carotid artery; COA, carotico-ophthalmic artery; BA, basilar artery; VA, vertebral artery; PcomA, posterior communicating artery; PCA, posterior cerebral artery; PICA, posterior inferior cerebellar artery.
- Table 2:
Hemodynamic modifications within visible side branches covered by the PED and consequences
Side Branches No. of PEDs Implanted No. of Side Branches Slow Flow within Side Branches Transient or Permanent Neurologic Deficitsa Territorial Ischemic Lesions on MRI Stenosis at 12-Mo Follow-Up Occlusion at 12-Mo Follow-Up Ophthalmic artery 1 25 3 0 NA 2 1 2 5 1 0 NA 1 0 3 1 0 0 NA 0 1 4 3 1 0 NA 0 0 Anterior choroidal artery 1 11 0 3 0 0 0 2 1 0 0 0 0 0 ACA 1 5 5 3 0 5 0 Callosomarginal artery 1 1 0 0 0 0 0 MCA 1 5 3 2 1 1 0 PcomA 1 2 0 0 0 0 0 PICA 1 5 0 0 0 2 0 2 1 0 0 0 0 0 SCA 3 1 0 0 0 0 0 PCA 3 1 0 0 0 0 0 Anterior spinal artery 1 1 0 0 0 0 0 Total 68 13 (19.1%) 8 1 11 2 Perforators Sylvian perforators 1 4 NA 3 1 NA NA 2 1 NA 0 0 NA NA BA perforators 3 1 NA 0 0 NA NA 5 1 NA 0 0 NA NA Total 7 NA 3 1 NA NA Note:—SCA indicates superior cerebellar artery; NA, not available; BA, basilar artery; PcomA, posterior communicating artery; PCA, posterior cerebral artery; PICA, posterior inferior cerebellar artery.
↵a Related to the side branch covered.
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