CASE STUDY

First use of Pipeline Embolization Device (PED) in Oregon

Endovascular neurosurgeon Erik F. Hauck, MD, PhD, is the first surgeon in Oregon, and one of a handful of surgeons on the west coast, to use the Pipeline Embolization Device (PED) to treat a large-necked aneurysm. He treated his first patient on July 28, 2011, at Sacred Heart Medical Center at RiverBend. Dr. Luca Valvasori of Milan, Italy, proctored the procedure.

The PED flexible stent was recently approved by the US Food and Drug Administration to treat large or giant, wide-necked aneurysms of the internal carotid artery. When placed across the neck of an aneurysm, the PED is intended to divert blood flow away from the aneurysm, allowing the aneurysm itself to clot. The clot prevents rupture and can lead to shrinkage over time.

Subject: The patient was a 52-year-old woman with a complicated medical history.

Diagnosis: Patient recently had an extended stay in the hospital resulting from a carotid cavernous fistula, which caused a cerebellar hemorrhagic infarction with severe brain stem compression, a left basal ganglia hemorrhage for which she had a suboccipital craniectomy for evacuation of hematoma, DuraGen duraplasty and C1 laminectomy. Patient also had coiling of her carotid cavernous fistula. Patient had issues with hydrocephalus for which a programmable ventriculoperitoneal shunt was placed on the right side. Patient also had a G tube and J tube. Patient had an underlying aneurysm which was the likely cause of the carotid cavernous fistula.

Treatment: The patient was taken to the angio suite at Sacred Heart Medical Center at RiverBend on July 28, 2011, and placed under conscious sedation. Groin access was obtained by a single puncture of the right common femoral artery. Dr. Hauck positioned a catheter in the left common carotid artery and advanced into the left internal carotid artery. A Pipeline Embolization Device (PED) was placed across the neck of the aneurysm, which was located in the cavernous segment of the internal carotid artery. The neck measured 7-8 mm at its widest location. All catheters were withdrawn and the wound was closed with Mynx Vascular Closure Device.

Outcome: There were no procedure complications. Follow-up revealed stasis in the aneurysm. The patient was released to a rehabilitation facility the next day.

Before placement of PED stent
After placement of PED stent