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Complete obliteration of a basilar artery aneurysm after insertion of a self-expandable Leo stent into the basilar artery without coil embolization.

Juszkat R, Nowak S, Wieloch M, Zarzecka A - Korean J Radiol (2008 Jul-Aug)

Bottom Line: We report a case of a 45-year-old man who underwent endovascular treatment in the acute setting of a subarachnoid hemorrhage due to rupture of a wide-necked basilar trunk aneurysm.The patient was treated with stent implantation without coiling.A control angiographic scan obtained immediately after the procedure revealed significantly decreased intraaneurysmal flow.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery and Neurotraumatology, Poznan University of Medical Sciences, Poznan, Poland. radiologiamim@wp.pl

ABSTRACT
We report a case of a 45-year-old man who underwent endovascular treatment in the acute setting of a subarachnoid hemorrhage due to rupture of a wide-necked basilar trunk aneurysm. The patient was treated with stent implantation without coiling. A control angiographic scan obtained immediately after the procedure revealed significantly decreased intraaneurysmal flow. Follow-up angiography performed after one month demonstrated total aneurysm occlusion.

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Obliteration of basilar artery aneurysm in 45-year-old man.A. Non-enhanced CT scan reveals massive subarachnoid hemorrhage (Fisher grade IV) with intraventricular hemorrhage.B. Angiogram shows wide-necked, saccular aneurysm on basilar trunk and aplasia of left P1 segment of posterior cerebral artery.C. Angiographic road map displays stent placement.D. Angiogram immediately following stent deployment shows significantly decreased intraaneurysmal flow.E. Follow-up angiogram after one month demonstrates complete occlusion of aneurysm.
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Figure 1: Obliteration of basilar artery aneurysm in 45-year-old man.A. Non-enhanced CT scan reveals massive subarachnoid hemorrhage (Fisher grade IV) with intraventricular hemorrhage.B. Angiogram shows wide-necked, saccular aneurysm on basilar trunk and aplasia of left P1 segment of posterior cerebral artery.C. Angiographic road map displays stent placement.D. Angiogram immediately following stent deployment shows significantly decreased intraaneurysmal flow.E. Follow-up angiogram after one month demonstrates complete occlusion of aneurysm.

Mentions: A 45-year-old man was admitted to the hospital with a suspicion of subarachnoid hemorrhage (SAH). The patient presented with psychomotor slowdown, limited verbal contact and disorientation. The patient was in Hunt and Hess grade III. A non-contrast computerized tomography (CT) scan of the patient confirmed the presence of massive SAH (Fisher grade IV) with intraventricular hemorrhage (Fig. 1A). Shortly after admission, the patient experienced sudden cardiac arrest and the patient was resuscitated. The patient was connected to a respirator and his state was stabilized. External ventricular drainage was performed and the clinical condition improved. After removal of ventricular drainage, digital subtraction angiography (DSA) was performed. DSA demonstrated the presence of a wide-neck, lobular, saccular aneurysm on the basilar trunk between the superior cerebellar artery and the anterior inferior cerebellar artery, with a diameter of approximately 6 mm and neck length of 4 mm (Fig. 1B). DSA also revealed aplasia of the P1 segment on the left side. A decision to perform endovascular treatment was made. Considering the length of the neck and the risk associated with protrusion of the coils, a decision to perform stent implantation was made. The patient was preloaded with 150 mg acetylsalicylic acid (ASA, aspirin). In our institution, patients in acute setting of SAH are preloaded only with ASA. In our opinion, its use carries a lower risk of hemorrhagic complications during the procedure than the use of dual antiplatelet therapy with ASA and clopidogrel. The patient provided informed consent and the patient was then sedated. The procedure was performed under general anaesthesia. The patient was administered 5,000 units of heparin intravenously during the procedure to maintain an activated clotting time of 250-350 after the femoral sheath was introduced. A 6-Fr guiding catheter Casasco (Balt, Montmorency, France) was introduced into the left vertebral artery. Through the guiding catheter, a Vasco 21+ microcatheter (Balt, Montmorency, France) was navigated on a 0.014 guidewire (Balt, Montmorency, France) to the parent vessel distally to the aneurysmal neck. The delivery system of the Leo stent (Balt, Montmorency, France) was then introduced inside the Vasco microcatheter. A Leo stent is a nitinol, closed-cell, self-expandable stent dedicated to intracranial circulation. Two platinum threads along the entire length of the stent enable visualization of the stent (both the length and diameter). The stent is resheathable when up to 90% is deployed.


Complete obliteration of a basilar artery aneurysm after insertion of a self-expandable Leo stent into the basilar artery without coil embolization.

Juszkat R, Nowak S, Wieloch M, Zarzecka A - Korean J Radiol (2008 Jul-Aug)

Obliteration of basilar artery aneurysm in 45-year-old man.A. Non-enhanced CT scan reveals massive subarachnoid hemorrhage (Fisher grade IV) with intraventricular hemorrhage.B. Angiogram shows wide-necked, saccular aneurysm on basilar trunk and aplasia of left P1 segment of posterior cerebral artery.C. Angiographic road map displays stent placement.D. Angiogram immediately following stent deployment shows significantly decreased intraaneurysmal flow.E. Follow-up angiogram after one month demonstrates complete occlusion of aneurysm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627273&req=5

Figure 1: Obliteration of basilar artery aneurysm in 45-year-old man.A. Non-enhanced CT scan reveals massive subarachnoid hemorrhage (Fisher grade IV) with intraventricular hemorrhage.B. Angiogram shows wide-necked, saccular aneurysm on basilar trunk and aplasia of left P1 segment of posterior cerebral artery.C. Angiographic road map displays stent placement.D. Angiogram immediately following stent deployment shows significantly decreased intraaneurysmal flow.E. Follow-up angiogram after one month demonstrates complete occlusion of aneurysm.
Mentions: A 45-year-old man was admitted to the hospital with a suspicion of subarachnoid hemorrhage (SAH). The patient presented with psychomotor slowdown, limited verbal contact and disorientation. The patient was in Hunt and Hess grade III. A non-contrast computerized tomography (CT) scan of the patient confirmed the presence of massive SAH (Fisher grade IV) with intraventricular hemorrhage (Fig. 1A). Shortly after admission, the patient experienced sudden cardiac arrest and the patient was resuscitated. The patient was connected to a respirator and his state was stabilized. External ventricular drainage was performed and the clinical condition improved. After removal of ventricular drainage, digital subtraction angiography (DSA) was performed. DSA demonstrated the presence of a wide-neck, lobular, saccular aneurysm on the basilar trunk between the superior cerebellar artery and the anterior inferior cerebellar artery, with a diameter of approximately 6 mm and neck length of 4 mm (Fig. 1B). DSA also revealed aplasia of the P1 segment on the left side. A decision to perform endovascular treatment was made. Considering the length of the neck and the risk associated with protrusion of the coils, a decision to perform stent implantation was made. The patient was preloaded with 150 mg acetylsalicylic acid (ASA, aspirin). In our institution, patients in acute setting of SAH are preloaded only with ASA. In our opinion, its use carries a lower risk of hemorrhagic complications during the procedure than the use of dual antiplatelet therapy with ASA and clopidogrel. The patient provided informed consent and the patient was then sedated. The procedure was performed under general anaesthesia. The patient was administered 5,000 units of heparin intravenously during the procedure to maintain an activated clotting time of 250-350 after the femoral sheath was introduced. A 6-Fr guiding catheter Casasco (Balt, Montmorency, France) was introduced into the left vertebral artery. Through the guiding catheter, a Vasco 21+ microcatheter (Balt, Montmorency, France) was navigated on a 0.014 guidewire (Balt, Montmorency, France) to the parent vessel distally to the aneurysmal neck. The delivery system of the Leo stent (Balt, Montmorency, France) was then introduced inside the Vasco microcatheter. A Leo stent is a nitinol, closed-cell, self-expandable stent dedicated to intracranial circulation. Two platinum threads along the entire length of the stent enable visualization of the stent (both the length and diameter). The stent is resheathable when up to 90% is deployed.

Bottom Line: We report a case of a 45-year-old man who underwent endovascular treatment in the acute setting of a subarachnoid hemorrhage due to rupture of a wide-necked basilar trunk aneurysm.The patient was treated with stent implantation without coiling.A control angiographic scan obtained immediately after the procedure revealed significantly decreased intraaneurysmal flow.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery and Neurotraumatology, Poznan University of Medical Sciences, Poznan, Poland. radiologiamim@wp.pl

ABSTRACT
We report a case of a 45-year-old man who underwent endovascular treatment in the acute setting of a subarachnoid hemorrhage due to rupture of a wide-necked basilar trunk aneurysm. The patient was treated with stent implantation without coiling. A control angiographic scan obtained immediately after the procedure revealed significantly decreased intraaneurysmal flow. Follow-up angiography performed after one month demonstrated total aneurysm occlusion.

Show MeSH
Related in: MedlinePlus