Successful endovascular treatment of three fusiform cerebral aneurysms with the Pipeline Embolization Device in a patient with dilating HIV vasculopathy

We read with much interest the recent paper by Delgado et al. 1 Credit must be given to the authors for several points: first, it is a first-time reported treatment with a flow diverter stent in this rare type of HIV vasculitis; second, from a technical viewpoint, good vascular remodeling was indeed obtained from stenting, as nicely shown in their well-illustrated paper; third, few studies have discussed the indications for endovascular therapy in such arteriopathies.

However, we would like to formulate major differences of opinion about such a procedure in light of our institutional experience and other published data:

First, these fusiform HIV-related aneurysms are not usually complicated with rupture and hemorrhage.2 In our experience, as a specialized center in both neuroradiology and infectiology, rupture of HIV-related fusiform aneurysms is quite exceptional.3

Second, subarachnoid hemorrhage (SAH) was not proved for the patient...

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