PT  - JOURNAL ARTICLE
AU  - Benjamin Fox
AU  - William Edward Humphries
AU  - Vinodh T Doss
AU  - Daniel Hoit
AU  - Lucas Elijovich
AU  - Adam S Arthur
TI  - Rupture of giant vertebrobasilar aneurysm following flow diversion: mechanical stretch as a potential mechanism for early aneurysm rupture
AID  - 10.1136/bcr-2014-011325
DP  - 2014 Oct 29
TA  - BMJ Case Reports
PG  - bcr2014011325
VI  - 2014
4099  - http://casereports.bmj.com/content/2014/bcr-2014-011325.short
4100  - http://casereports.bmj.com/content/2014/bcr-2014-011325.full
AB  - A patient with a giant symptomatic vertebrobasilar aneurysm was treated by endoscopic third ventriculostomy for obstructive hydrocephalus followed by treatment of the aneurysm by flow diversion using a Pipeline Embolization Device. After an uneventful procedure and initial periprocedural period, the patient experienced an unexpected fatal subarachnoid hemorrhage 1 week later. Autopsy demonstrated extensive subarachnoid hemorrhage and aneurysm rupture (linear whole wall rupture). The patent Pipeline Embolization Device was in its intended location, as was the persistent coil occlusion of the distal left vertebral artery. The aneurysm appeared to rupture in a linear manner and contained a thick large expansile clot that seemed to disrupt or rupture the thin aneurysm wall directly opposite the basilar artery/Pipeline Embolization Device. We feel the pattern of aneurysm rupture in our patient supports the idea that the combination of flow diversion and the resulting growing intra-aneurysmal thrombus can create a mechanical force with the potential to cause aneurysm rupture.