Endovascular Management of Traumatic Intracranial Aneurysms Using the Pipeline Flex Embolization Device With Shield Technology Under Single Antiplatelet Therapy: A Case Report and Literature Review.

Traumatic intracranial aneurysms (TICAs) are rare but critical lesions that develop following head injury, carrying a high risk of rupture due to their nature as pseudoaneurysms. Traditional treatments, such as surgical clipping/ligation and coil embolization, have been used to manage TICAs; however, these approaches have significant limitations, including high invasiveness and risk of rebleeding. Flow diverter stents (FDS) have emerged as a promising parent vessel-preserving option, yet managing periprocedural antiplatelet therapy remains a significant challenge, particularly in polytrauma patients. A critical question persists: can FDS be safely and effectively deployed with a minimized antiplatelet burden in patients at high risk of bleeding? This report describes a single case and reviews existing literature on FDS treatment for TICAs, specifically highlighting reports demonstrating the safety and efficacy of single antiplatelet therapy (SAPT) using the Pipeline Flex Embolization Device with Shield Technology (PED-Shield, Medtronic Inc., Irvine, CA, USA). The patient was a woman who sustained a severe head injury from traffic trauma, presenting with bilateral petrous bone fractures, a clivus fracture, and subarachnoid hemorrhage within the basal cisterns and bilateral Sylvian fissures. Initial CT angiography (CTA) on the day of injury showed no aneurysm; however, CTA on post-injury day 8 revealed a new pseudoaneurysm at the petrous-to-cavernous junction of the right internal carotid artery. Given her high bleeding risk due to polytrauma and a brain contusion necessitating decompressive craniectomy on post-injury day 2, PED-Shield was deployed under SAPT, with aspirin as the sole antiplatelet agent. The postoperative course was uneventful. Although the patient experienced attention deficits due to the cerebral contusion, she is living independently with a modified Rankin Scale score of 3. Angiography at 25 days confirmed complete aneurysm occlusion with excellent parent vessel preservation; this favorable outcome persisted at the seven-month follow-up. Our experience suggests that FDS can effectively prevent early rupture and achieve successful occlusion in TICAs. This observation aligns with existing literature demonstrating high complete occlusion rates and the ability to avoid delayed rupture with FDS treatment of TICAs. Furthermore, this case highlights a particularly significant advancement: despite no previous reports of PED-Shield use under SAPT in trauma cases, its antithrombogenic surface coating allowed treatment with SAPT, effectively mitigating the constraints of dual antiplatelet therapy (DAPT) in polytrauma patients. This approach is supported by several reports indicating the safety and efficacy of minimized antiplatelet therapy with PED-Shield in nontraumatic cases. FDS can preserve the parent vessel while ensuring durable aneurysm exclusion. In polytrauma patients, PED-Shield may reduce the limitations imposed by DAPT. This strategy represents a valuable addition to the treatment armamentarium for TICAs.