Anterior Communicating Artery Aneurysm: Procedural Aneurysmal Re-rupture during pCONus1 Deployment, Device Thrombosis during Coil Occlusion of the Aneurysm, Recanalization of the pCONus1 by Infusion of Eptifibatide
- 71 Downloads
A 52-year-old male patient presented having suffered from headaches, neck stiffness, and varying paresthesia for 2 weeks. MRI/MRA showed a subacute subarachnoid hemorrhage (SAH) in the interhemispheric fissure and an aneurysm of the anterior communicating artery (AcomA). The SAH was graded as Hunt and Hess I and Fisher I. The decision was made to treat this aneurysm by endovascular means. Since the aneurysm neck was wide, a pCONus1 bifurcation stent (phenox) was implanted. Upon deployment of said stent in the neck region of the aneurysm, a minor extravasation of the blood from the aneurysm into the subarachnoid space was observed. At that moment, the patient had already received 500 mg ASA IV and 180 mg ticagrelor PO via a nasogastric tube. The intended IV injection of eptifibatide was still pending. With the pCONus1 stent in place, the aneurysm was occluded with 18 detachable coils. A DSA carried out 38 min after the extravasation had been noticed showed a complete thrombotic occlusion of the pCONus1 shaft. An eptifibatide bolus was given both through IV and IA. This resulted in a complete resolution of the thrombus within 11 min, with reperfusion of both anterior cerebral arteries (ACAs). The patient recovered well from this procedure. A midterm follow-up DSA confirmed the complete occlusion of the aneurysm. The treatment of wide-necked bifurcation aneurysms in the acute phase after SAH using pCONus and the neuroendovascular usage of eptifibatide are the main topics of this chapter.
KeywordsAnterior communicating artery SAH pCONus Coils Procedural aneurysm rupture Stent thrombosis Eptifibatide
- Bechan RS, Sprengers ME, Majoie CB, Peluso JP, Sluzewski M, van Rooij WJ. Stent-assisted coil embolization of intracranial aneurysms: complications in acutely ruptured versus unruptured aneurysms. AJNR Am J Neuroradiol. 2016;37(3):502–7. https://doi.org/10.3174/ajnr.A4542.CrossRefPubMedGoogle Scholar
- Ramakrishnan P, Yoo AJ, Rabinov JD, Ogilvy CS, Hirsch JA, Nogueira RG. Intra-arterial eptifibatide in the management of thromboembolism during endovascular treatment of intracranial aneurysms: case series and a review of the literature. Interv Neurol. 2013;2(1):19–29. https://doi.org/10.1159/000354982.CrossRefPubMedPubMedCentralGoogle Scholar
- Sedat J, Chau Y, Mondot L, Chemla R, Lonjon M, Padovani B. Is eptifibatide a safe and effective rescue therapy in thromboembolic events complicating cerebral aneurysm coil embolization? Single-center experience in 42 cases and review of the literature. Neuroradiology. 2014;56(2):145–53. https://doi.org/10.1007/s00234-013-1301-3.CrossRefPubMedGoogle Scholar