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Ton MD, Phuong DV, Tho PQ, Dung NT, Tuan TA, Thien NT. Management of ruptured aneurysmal subarachnoid hemorrhage with multiple basilar trunk aneurysms using a flow-diverter stent: A case report. Radiol Case Rep 2024; 19:2629-2632. [PMID: 38645949 PMCID: PMC11026529 DOI: 10.1016/j.radcr.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 04/23/2024] Open
Abstract
Ruptured aneurysmal subarachnoid hemorrhage associated with multiple basilar trunk aneurysms represents a rare clinical condition. Endovascular intervention stands as the preferred therapeutic approach. We present the case of a 35-year-old patient with subarachnoid hemorrhage and three consecutive basilar trunk aneurysms. Utilizing a flow-diverter stent, we achieved simultaneous occlusion of all 3 aneurysms, performed 2 hours post dual antiplatelet therapy (comprising salicylic acid 300 mg and ticagrelor 180 mg). Sustained resistance to clopidogrel necessitated the subsequent 3 months, followed by single antiplatelet therapy. At the 1-month follow-up, the patient demonstrated a favorable clinical course, devoid of cerebral infarction, and evidenced unobstructed stent patency upon brain magnetic resonance imaging.
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Affiliation(s)
- Mai D. Ton
- Stroke Center, Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
- Hanoi Medical University, No 1, Ton That Tung Street, Dong Da District, Hanoi, Vietnam
- VNU University of Medicine and Pharmacy; 144 Xuan Thuy Street, Cau Giay District, Hanoi, Vietnam
| | - Dao V. Phuong
- Stroke Center, Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
- Hanoi Medical University, No 1, Ton That Tung Street, Dong Da District, Hanoi, Vietnam
- VNU University of Medicine and Pharmacy; 144 Xuan Thuy Street, Cau Giay District, Hanoi, Vietnam
| | - Pham Q. Tho
- Stroke Center, Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
| | - Nguyen T. Dung
- Stroke Center, Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
- Hanoi Medical University, No 1, Ton That Tung Street, Dong Da District, Hanoi, Vietnam
- VNU University of Medicine and Pharmacy; 144 Xuan Thuy Street, Cau Giay District, Hanoi, Vietnam
| | - Tran A. Tuan
- Stroke Center, Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
- VNU University of Medicine and Pharmacy; 144 Xuan Thuy Street, Cau Giay District, Hanoi, Vietnam
- Radiology Center, Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
| | - Nguyen T. Thien
- Radiology Center, Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam
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Zhang XH, Zhao XY, Liu LL, Wen L, Wang GX. Identification of ruptured intracranial aneurysms using the aneurysm-specific prediction score in patients with multiple aneurysms with subarachnoid hemorrhages- a Chinese population based external validation study. BMC Neurol 2022; 22:201. [PMID: 35650546 PMCID: PMC9158357 DOI: 10.1186/s12883-022-02727-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background For patients with aneurysmal subarachnoid hemorrhages (SAHs) and multiple intracranial aneurysms (MIAs), a simple and fast imaging method that can identify ruptured intracranial aneurysms (RIAs) may have great clinical value. We sought to use the aneurysm-specific prediction score to identify RIAs in patients with MIAs and evaluate the aneurysm-specific prediction score. Methods Between May 2018 and May 2021, 134 patients with 290 MIAs were retrospectively analyzed. All patients had an SAH due to IA rupture. CT angiography (CTA) was used to assess the maximum diameter, shape, and location of IAs to calculate the aneurysm-specific prediction score. Then, the aneurysm-specific prediction score was applied to RIAs in patients with MIAs. Results The IAs with the highest aneurysm-specific prediction scores had not ruptured in 17 (12.7%) of the 134 patients with 290 MIAs. The sensitivity, specificity, false omission rate, diagnostic error rate, and diagnostic accuracy of the aneurysm-specific prediction score were higher than those of the maximum diameter, shape, and location of IAs. Conclusions The present study suggests that the aneurysm-specific prediction score has high diagnostic accuracy in identifying RIAs in patients with MIAs and SAH, but that it needs further evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02727-w.
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Inci S, Karakaya D. Kissing Aneurysms: Radiological and Surgical Difficulties in 30 Operated Cases and a Proposed Classification. World Neurosurg 2021; 155:e83-e94. [PMID: 34384920 DOI: 10.1016/j.wneu.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The first aim of this study is to bring up the radiological and surgical difficulties of kissing aneurysms and to present solutions. The second aim is to develop a classification that can help to predict the difficulties encountered during surgery. METHODS The records of 817 patients who were operated on for aneurysm were reviewed retrospectively to identify kissing aneurysms. The radiological and clinical databases of these patients were evaluated in detail. RESULTS Kissing aneurysms were detected in 30 patients (3.6%). Radiologically correct diagnosis rate of kissing aneurysms was 80% throughout the series. The most common locations were the anterior communicating artery (12 cases, 40%) and the middle cerebral artery (12 cases, 40.0%). The ruptured aneurysm could not be detected preoperatively in 24% of the patients. Intraoperative rupture occurred in 4 patients (13.3%). Accompanying vascular anomaly/variation was seen in 16 patients (53.3%). As detailed in the text, kissing aneurysms were divided into 3 types according to their position with each other on the parent artery from the surgeon's point of view during surgery: type I (proximal/distal), type II (superior/inferior), and type III (right/left). CONCLUSIONS Despite advanced angiographic techniques, even today, kissing aneurysms can be misinterpreted as a single bilobular aneurysm. The ruptured aneurysm may not be detectable preoperatively. These complex aneurysms have a high intraoperative rupture risk. Accompanying vascular anomalies are more common than expected. Clip selection and sequencing are important. Proposed classification helps the surgeon to be aware of intraoperative difficulties that he/she may encounter in advance.
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Affiliation(s)
- Servet Inci
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey.
| | - Dicle Karakaya
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey
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