Basilar Artery Bifurcation Aneurysm: Acute SAH, Ruptured Wide Neck Basilar Bifurcation Aneurysm, Medina and Coil Occlusion Assisted by pCONus2, Early Interruption of Antiaggregation Without Sequelae
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A large, wide necked ruptured aneurysm of the basilar artery bifurcation was treated by endovascular Medina- (Medtronic) and coil occlusion assisted by pCONus2 (phenox). This combination of implants allowed the interruption of the blood circulation inside the aneurysm despite a neck width of 9 mm. The procedure has been carried out under dual antiaggregation with acetylsalicylic acid (ASA; Aspirin i.v., Bayer Vital) and ticagrelor (Brilique, AstraZeneca). Immediately after the treatment, a minor perfusion of the aneurysm dome was still visible, which had ceased 3 days later. The administration of ticagrelor had been inadvertently stopped 1 month after the treatment, while the administration of 100 mg ASA PO daily was continued. A thromboembolic complication did not occur. The patient, whose clinical condition was initially Hunt and Hess III, recovered significantly within 2 months in the hospital and having 2 months of rehabilitation. Angiographic follow-up 3 and 12 months after the treatment confirmed a stable obliteration of the aneurysm. The use of pCONus2 and Medina is the main topic of this report.
KeywordsBasilar artery bifurcation aneurysm SAH pCONus2 Medina Antiaggregation
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