Quick example of a simpler approach to a problem — MCA bifurcation aneurysms have varied anatomy and relationship between vessels and aneurysm. Hence a variety of approaches — including still open surgery. In the endovascular arena, simplicity of treatment and efficacy continue to be challenging
Here is an example of Pipeline Shield Rx
Cone beam DYNA CT shows multilobulated MCA aneurysm — including a particularly proximal lobule that would be difficult to either coil or WEB with confidence
The straightforward plan is for Pipeline Shield
Sizing is important — overizing by a bit in MCA can be helpful. Here we chose not to, and deliver a single device.
As much as we talk about multi-device coverage — for MCA and other large low resistance vessels (like fetal PCA) a single well sized device is a good idea. Also key to have adequate antiplatelet coverage — acute thrombus formation is what takes these down. P2Y12 is essential here
Also key to have strategic coverage — no reason to cover any more perforators or branches than needed — so shorter devices are important