Anterior Communicating Artery Aneurysm: Blister-Like Aneurysm of the Anterior Communicating Artery Treated by Flow Diversion Two Weeks After Subarachnoid Hemorrhage
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A ruptured blister-like aneurysm was found on the anterior communicating artery (AcomA) of a patient who presented with an intense headache which had started 3 days ago. The patient was found to have a subarachnoid hemorrhage (SAH) and remained in the ICU without complications. Twelve days after the hemorrhage, dual antiplatelet medication was initiated. Two days later, a low-profile flow diverter device (FRED Jr., MicroVention) was successfully implanted. This case illustrates the benefits of using endovascular reconstructive techniques on the vessel when intrasaccular occlusion of the aneurysm is not technically feasible. Once an aneurysm has been completely occluded by an extrasaccular flow-diverting device, recurrence of this aneurysm is very unlikely. We will also discuss the possibility of starting dual antiplatelet medication in the acute phase after SAH. Flow diversion in the acute phase after SAH is the main topic of this chapter.
KeywordsAnterior communicating artery Subarachnoid hemorrhage Flow diversion Ruptured blister aneurysm Dual antiplatelet medication FRED Jr
- Dabus G, Grossberg JA, Cawley CM, Dion JE, Puri AS, Wakhloo AK, Gonsales D, Aguilar-Salinas P, Sauvageau E, Linfante I, Hanel RA. Treatment of complex anterior cerebral artery aneurysms with pipeline flow diversion: mid-term results. J Neurointerv Surg. 2017 Feb;9(2):147–51. https://doi.org/10.1136/neurintsurg-2016-012519.CrossRefPubMedGoogle Scholar
- Hu YC, Deshmukh VR, Albuquerque FC, Fiorella D, Nixon RR, Heck DV, Barnwell SL, McDougall CG. Histopathological assessment of fatal ipsilateral intraparenchymal hemorrhages after the treatment of supraclinoid aneurysms with the pipeline embolization device. J Neurosurg. 2014 Feb;120(2):365–74. https://doi.org/10.3171/2013.11.JNS131599.CrossRefPubMedGoogle Scholar
- Kung DK, Policeni BA, Capuano AW, Rossen JD, Jabbour PM, Torner JC, Howard MA, Hasan D. Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling. J Neurosurg. 2011 Apr;114(4):1021–7. https://doi.org/10.3171/2010.9.JNS10445.CrossRefPubMedGoogle Scholar
- Lang ST, Assis Z, Wong JH, Morrish W, Mitha AP. Rapid delayed growth of ruptured supraclinoid blister aneurysm after successful flow diverting stent treatment. J Neurointerv Surg. 2017 Apr;9(4):e16. https://doi.org/10.1136/neurintsurg-2016-012506.rep.CrossRefPubMedGoogle Scholar
- Meling TR, Sorteberg A, Bakke SJ, Slettebø H, Hernesniemi J, Sorteberg W. Blood blister-like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome. J Neurosurg. 2008 Apr;108(4):662–71. https://doi.org/10.3171/JNS/2008/108/4/0662.CrossRefPubMedGoogle Scholar
- Mokin M, Chinea A, Primiani CT, Ren Z, Kan P, Srinivasan VM, Hanel R, Aguilar-Salinas P, Turk AS, Turner RD, Chaudry MI, Ringer AJ, Welch BG, Mendes Pereira V, Renieri L, Piano M, Elijovich L, Arthur AS, Cheema A, Lopes DK, Saied A, Baxter BW, Hawk H, Puri AS, Wakhloo AK, Shallwani H, Levy EI, Siddiqui AH, Dabus G, Linfante I. Treatment of blood blister aneurysms of the internal carotid artery with flow diversion. J Neurointerv Surg. 2018. pii: neurintsurg-2017-013701; https://doi.org/10.1136/neurintsurg-2017-013701.
- Rouchaud A, Brinjikji W, Cloft HJ, Kallmes DF. Endovascular treatment of ruptured blister like aneurysms: a systematic review and meta-analysis with focus on deconstructive versus reconstructive and flow-diverter treatments. AJNR Am J Neuroradiol. 2015;36(12):2331–9. https://doi.org/10.3174/ajnr.A4438.CrossRefPubMedGoogle Scholar
- Yang C, Vadasz A, Szikora I. Treatment of ruptured blood blister aneurysms using primary flow-diverter stenting with considerations for adjunctive coiling: a single-Centre experience and literature review. Interv Neuroradiol. 2017;23(5):465–76. https://doi.org/10.1177/1591019917720805.CrossRefPubMedPubMedCentralGoogle Scholar
- Yoon JW, Siddiqui AH, Dumont TM, Levy EI, Hopkins LN, Lanzino G, Lopes DK, Moftakhar R, Billingsley JT, Welch BG, Boulos AS, Yamamoto J, Tawk RG, Ringer AJ, Hanel RA. Endovascular neurosurgery research group. Feasibility and safety of pipeline embolization device in patients with ruptured carotid blister aneurysms. Neurosurgery. 2014;75(4):419–29. Discussion 429. https://doi.org/10.1227/NEU.0000000000000487.CrossRefPubMedGoogle Scholar
- Yu D-W, Jung Y-J, Choi B-Y, Chang C-H. Subarachnoid hemorrhage with negative baseline digital subtraction angiography: is repeat digital subtraction angiography necessary? J Cerebrovasc Endovasc Neurosurg. 2012;14(3):210–5. https://doi.org/10.7461/jcen.2012.14.3.210.CrossRefPubMedPubMedCentralGoogle Scholar