Abstract
A 59-year-old male patient presented to the referring hospital after waking up with left arm weakness and left lower leg and foot paresthesia. Magnetic resonance imaging / Magnetic resonance angiography (MRI/MRA) showed several embolic lesions in the right middle cerebral artery (MCA) territory and a small aneurysm (fundus diameter 3 mm) at the bifurcation of the left internal carotid artery (ICA). Further work-up revealed an activated protein C resistance due to a heterozygous factor V Leiden mutation, an elevated plasma homocysteine level, and a patent foramen ovale (PFO) measuring 8 mm. Cerebral angiography was carried out 2 weeks after the initial stroke and confirmed the left ICA bifurcation aneurysm. Ten weeks after the onset of stroke, the PFO was occluded with a 25-mm Amplatzer PFO Occluder (Abbott) and the patient was started on 1× 100 mg acetylsalicylic acid (ASA) and 1× 75 mg clopidogrel PO daily. MRI/MRA 5 weeks later demonstrated the known ICA bifurcation aneurysm, the patient was referred to us and aneurysm treatment with a flow diverter stent was planned. Digital subtraction angiography (DSA) performed 7 months after his minor stroke and 4 months after the PFO occlusion demonstrated spontaneous thrombosis of the aneurysm, despite the patient being on dual antiplatelet therapy (DAPT). The rare phenomenon of spontaneous complete thrombosis of intracranial aneurysms is the main topic of this chapter.
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Gihr, G., Felber, S., Bäzner, H., Henkes, H. (2019). Internal Carotid Artery Bifurcation Aneurysm: Spontaneous Thrombosis of an Incidental ICA Bifurcation Aneurysm Despite Dual Platelet Function Inhibition. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_126-1
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