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The advent of flow diverters (FDs) has changed the scope of endovascular treatment options for intracranial aneurysms (IAs). FDs can effectively treat complex aneurysms in which both microsurgical and conventional endovascular options are less than ideal.1 2 The Pipeline Flex Embolization Device (PED; Medtronic, Irvine, California, USA) has been available in the USA for several years demonstrating positive results. More recently, the PED Flex with enhanced delivery features has been introduced, and although decreased, thromboembolic complications are still a potential risk.3 In light of this, a new surface modification was applied to the PED Flex known as Shield Technology consisting of a phosphorylcholine layer covalently bound to its metal braids potentially reducing its thrombogenicity.4 Herein, we report our initial experience using the PED Flex with Shield Technology in the treatment of an unruptured fusiform aneurysm located in the middle cerebral artery (MCA) using dual-antiplatelet therapy.
A 32-year-old woman with history of sudden onset of headache and no other major relevant medical history presented for medical evaluation. Initial head CT and MRI showed no evidence of any haemorrhage, but MRI depicted a possible left MCA aneurysm. A CT angiography (CTA) revealed an unruptured fusiform aneurysm involving the inferior division of the left MCA. Treatment options consisting of observation, clip-wrapping, bypass or possible off-label use of PED were discussed with the patient. Decision was made to perform a cerebral angiogram and a three-dimensional reconstruction, with final therapeutic decision to be made based on bifurcation involvement. If both the superior and inferior divisions were involved, the treatment plan would consist of clip-wrapping but, if only the inferior division was diseased, then the plan was to use the PED. Cerebral angiogram demonstrated the complex morphology of the lesion exclusively compromising the inferior division of the MCA with two components measuring 3.9 mm × 3.0 mm and …
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