Abstract
A 39-year-old female patient was referred to a neurologist by her general practitioner for the work-up of headache. The performed MRI/MRA examination revealed two tandem aneurysms of the right middle cerebral artery (MCA): the first aneurysm arose from the first temporal branch of the MCA measuring 3 mm; the second aneurysm was located at the MCA bifurcation with a diameter of 6 mm. In accordance with the patient’s wishes endovascular treatment of both aneurysms was planned. During coiling of the smaller aneurysm, a coil loop ruptured the aneurysm wall and the extravasation did not resolve with temporary balloon occlusion of the M1/M2 segment. Therefore, the aneurysm and its parent artery were occluded with nBCA injection under balloon protection, which resulted in instantaneous hemostasis. The resulting right temporal lobe infarct remained asymptomatic. The second aneurysm was treated 3 weeks later by pCONus1_HPC assisted coil occlusion under ASA monotherapy. A follow-up DSA 3 months later confirmed the satisfactory occlusion of both aneurysms. The management of periprocedural aneurysm rupture and the intracranial use of coated stent derivatives with reduced thrombogenicity are the main topics of this chapter.
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Pérez, M.A., Hellstern, V., AlMatter, M., Bäzner, H., Henkes, H. (2019). Middle Cerebral Artery Bifurcation Aneurysm: Incidental Tandem Aneurysms of the Middle Cerebral Artery; Periprocedural Rupture of a Temporal Artery Aneurysm During Coil Insertion; Sealing of the Rupture Site and Parent Vessel Occlusion with nBCA; Subsequent Coil Occlusion of an MCA Bifurcation Aneurysm Assisted by a pCONus1_HPC Device Under Mono-antiaggregation with ASA Only. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_100-1
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