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Vandenbulcke A, Messerer M, Starnoni D, Puccinelli F, Daniel RT, Cossu G. Complete spontaneous thrombosis in unruptured non-giant intracranial aneurysms: A case report and systematic review. Clin Neurol Neurosurg 2020; 200:106319. [PMID: 33268195 DOI: 10.1016/j.clineuro.2020.106319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/07/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM Spontaneous partial or complete thrombosis of saccular unruptured intracranial aneurysm (UIAs) is a known occurrence in giant aneurysms. However, spontaneous complete thrombosis of non-giant aneurysms is a rare event in the natural history of UIAs. The aim of this paper is to report on the cases from literature of complete spontaneous thrombosis with a view to identify possible factors associated with this phenomenon. MATERIAL AND METHODS We performed a systematic review of the current literature on spontaneous complete thrombosis of saccular, non-giant, unruptured UIAs, including a case that we treated at our institution. We analysed the possible risk factors for thrombosis, association with ischemic events, rupture and recanalization. We reviewed the possible management's strategies for this group of patients described in literature to date. RESULTS We identified 26 patients for a total of 27 thrombosed aneurysms from the literature review (including our case). Thrombosis was prevalent in women, in the anterior circulation and in larger aneurysms. Endovascular events in the parent artery, either spontaneous or iatrogenic, were associated with spontaneous thrombosis in 4 cases. In 47 % of cases an antiplatelet treatment (AP) was introduced. Rupture and recanalization of the aneurysm were observed in 14 % and 33 % respectively. A larger size was the only factor statistically associated with rupture (P = 0041). AP was not statistically associated with recanalization or rupture of the aneurysm. CONCLUSION Complete spontaneous thrombosis is not a curative event. Its natural history is associated with recanalization, rupture and ischemic stroke. Conservative treatment with a clinical-radiological follow up and treatment with AP is a safe option for small aneurysms. Definitive aneurysmal exclusion should be considered in medium and large aneurysms due to the significant risks associated with untreated aneurysms.
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Affiliation(s)
- Alberto Vandenbulcke
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Daniele Starnoni
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Francesco Puccinelli
- Department of Radiology, Section of Neuroradiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Giulia Cossu
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland.
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2
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Beneš V, Jurák L, Jedlička J, Dienelt J, Suchomel P. Fatal intracranial aneurysm rupture after thrombolytic treatment for ischemic stroke: a case report and literature review. Acta Neurochir (Wien) 2019; 161:1337-1341. [PMID: 31065893 DOI: 10.1007/s00701-019-03931-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/24/2019] [Indexed: 01/01/2023]
Abstract
Intravenous thrombolysis is a proven treatment of acute ischemic stroke. Its complications include intracranial hemorrhage; the risk may be increased in the presence of an unruptured aneurysm. We present a case report of a patient who suffered fatal subarachnoid hemorrhage after thrombolysis from a known aneurysm. A history of recent previously inexperienced headaches was revealed retrospectively, suggestive of sentinel bleedings. A similar patient was identified in the literature; we thus propose that this history should be excluded in patients harboring an aneurysm considered for thrombolytic treatment.
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Affiliation(s)
- Vladimír Beneš
- Department of Neurosurgery, Regional Hospital Liberec, Husova 10, 460 01, Liberec, Czech Republic.
| | - Lubomír Jurák
- Department of Neurosurgery, Regional Hospital Liberec, Husova 10, 460 01, Liberec, Czech Republic
| | - Jaroslav Jedlička
- Department of Neurosurgery, Regional Hospital Liberec, Husova 10, 460 01, Liberec, Czech Republic
| | - Jan Dienelt
- Department of Neurology, Regional Hospital Liberec, Husova 10, Liberec, 460 01, Czech Republic
| | - Petr Suchomel
- Department of Neurosurgery, Regional Hospital Liberec, Husova 10, 460 01, Liberec, Czech Republic
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Hadley C, Sheth S, Fargen KM, Srinivasan VM, Cherian J, Chen S, Johnson J, Kan P. Mechanical Thrombectomy for Acute Stroke in Patients with Target and Unrelated Vessel AVMs and AVFs: A Case Series. World Neurosurg 2019; 127:e1255-e1261. [PMID: 30986580 DOI: 10.1016/j.wneu.2019.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Advances in acute and long-term poststroke care have resulted in improved survival and functional outcomes for patients who have suffered large vessel ischemic strokes. For years, tissue plasminogen activator was the mainstay of treatment for acute stroke. Its use was previously limited to patients without known comorbid intracranial vascular pathology because of concern for bleeding risk. More recently, however, the use of tissue plasminogen activator in select patients with vascular anomalies has increased and is now largely thought to be safe. With the safety and efficacy of mechanical thrombectomy now proven for large vessel occlusions (LVOs), similar investigation is needed to assess procedural safety in patients with concomitant arteriovenous (AV) malformations or fistulae. METHODS We reviewed patients treated for LVOs at our institution and those of our collaborators and identified 6 patients who were treated for LVO with either known or incidentally identified concomitant AV malformations or dural AV fistulae. RESULTS We present a case series of 6 patients with nonaneurysmal intracranial vascular lesions who underwent mechanical thrombectomy for LVO without complications related to these lesions. CONCLUSIONS Although limited by small size, our series adds to the literature evidence that mechanical thrombectomy for LVO can safely be performed with concomitant dural AV fistulae and AV malformations.
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Affiliation(s)
- Caroline Hadley
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Sunil Sheth
- Department of Neurology, University of Texas Health Science Center, Houston, Texas, USA
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | | | - Jacob Cherian
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Stephen Chen
- Department of Interventional Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremiah Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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Endovascular Thrombectomy for Large-Vessel Occlusion Strokes with Preexisting Intracranial Aneurysms. Cardiovasc Intervent Radiol 2018; 41:1399-1403. [DOI: 10.1007/s00270-018-1945-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 03/20/2018] [Indexed: 10/16/2022]
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5
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Shono Y, Sugimori H, Matsuo R, Fukushima Y, Wakisaka Y, Kuroda J, Ago T, Kamouchi M, Kitazono T. Safety of antithrombotic therapy for patients with acute ischemic stroke harboring unruptured intracranial aneurysm. Int J Stroke 2018. [PMID: 29543141 DOI: 10.1177/1747493018765263] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The safety of antithrombotic therapy for patients with acute ischemic stroke harboring unruptured intracranial aneurysms remains unclear. Aims This study was performed to determine whether treatment with antiplatelets, anticoagulants, or intravenous thrombolytic agents is safe for patients with acute ischemic stroke and unruptured intracranial aneurysms. Methods Among 9149 patients with acute ischemic stroke enrolled in the Fukuoka Stroke Registry from June 2007 to December 2014, 8857 patients with data on cerebrovascular imaging and three-month outcomes were included in this study. The frequency of adverse events, including intracranial hemorrhage, symptomatic intracranial hemorrhage, and in-hospital mortality, was compared between patients with and without unruptured intracranial aneurysms. The risk of a poor functional outcome (modified Rankin scale score of ≥3) at three months after stroke onset was estimated after adjusting for confounding factors by logistic regression analysis. Results Unruptured intracranial aneurysms were identified in 412 (4.7%) patients, and the mean diameter was 4.1 ± 3.2 mm. There was no significant difference in the frequency of any adverse events between patients with and without unruptured intracranial aneurysms among the overall patients or patients receiving antiplatelets, anticoagulants, or intravenous thrombolytic agents. The odds ratios of a poor functional outcome were not significantly higher in the presence of unruptured intracranial aneurysms, even in patients undergoing antiplatelet therapy, anticoagulation therapy, or intravenous thrombolysis. Conclusions These findings suggest that unruptured intracranial aneurysms are not associated with increased risks of adverse events or poor functional outcomes even after antithrombotic therapy for acute ischemic stroke. However, accumulation of cases is required to verify these findings.
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Affiliation(s)
- Yuji Shono
- 1 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,2 Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroshi Sugimori
- 1 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,3 Stroke Center, Saga Medical Centre Koseikan, Saga, Japan
| | - Ryu Matsuo
- 1 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,4 Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihisa Fukushima
- 5 Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan
| | - Yoshinobu Wakisaka
- 1 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,6 Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junya Kuroda
- 1 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- 1 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- 4 Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,6 Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- 1 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,6 Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Singh J, Wolfe SQ. Stent retriever thrombectomy with aneurysm in target vessel: Technical note. Interv Neuroradiol 2016; 22:544-7. [PMID: 27301391 DOI: 10.1177/1591019916653257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/06/2016] [Indexed: 11/15/2022] Open
Abstract
Aneurysms within large occluded target vessels can present significant challenges for neuro interventionists because rupture can be catastrophic. We recently encountered a case of left internal carotid artery-middle cerebral artery (MCA) ischemic stroke with an incidental MCA bifurcation aneurysm that we were already aware of. IV tissue plasminogen activator (tPA) with mechanical thrombectomy (MTE) was performed with a stent retriever, proximal to the aneurysm. TICI 2b recanalization was achieved. MTE and IV tPA may not be withheld from patients with acute stroke with known target vessel aneurysms.
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Is it dangerous to treat acute ischemic stroke by thrombolytic therapy in patients with comorbid intracranial aneurysms? Am J Emerg Med 2016; 34:636-42. [DOI: 10.1016/j.ajem.2015.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 12/15/2015] [Indexed: 11/23/2022] Open
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Torikoshi S, Akiyama Y. A Concealed Intracranial Aneurysm Detected after Recanalization of an Occluded Vessel: A Case Report and Literature Review. INTERVENTIONAL NEUROLOGY 2016; 4:90-5. [PMID: 27051404 DOI: 10.1159/000443220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Based on the results of several randomized controlled trials, acute endovascular thrombectomy is strongly recommended for patients with acute ischemic stroke due to large artery occlusion (LAO). The incidence of an intracranial aneurysm has been reported to be approximately 5% in the general population. Therefore, the possibility of the coincidence of LAO and an intracranial aneurysm at the distal part of an occluded vessel should be considered. SUMMARY A 74-year-old female patient presented with the sudden onset of consciousness disturbance and left-sided weakness. Neuroimages demonstrated an acute infarction due to right middle cerebral artery occlusion. The occlusion was successfully treated, and an aneurysm was incidentally detected at the occluded artery. We reviewed the literature and identified 11 cases in 8 reports, which were similar to our case. Among the 11 cases, aneurysms ruptured during endovascular therapy in 2 cases. In the present report, we discussed the prediction of concealed aneurysms and avoidance of their rupture during endovascular intervention. KEY MESSAGE The presence of an aneurysm concealed behind an embolus should be carefully assessed on preoperative and intraoperative neuroimages. The important findings for suspecting such an aneurysm are a hyperdense nodular sign on preoperative computed tomography and unusual motion of the microwire during the endovascular intervention. Even if there is no finding indicative of an aneurysm, the catheter and thrombectomy devices should be more carefully advanced than usual, especially at the common sites of aneurysms, and the devices should be appropriately chosen.
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Asai K, Nakamura H, Sakaguchi M, Kawano T, Ozaki T, Ima H, Kidani T, Kadono Y, Murakami T, Yoshimine T. Direct aspiration first pass technique for a middle cerebral artery occlusion with a hidden aneurysm. Interv Neuroradiol 2015; 21:700-2. [PMID: 26472636 DOI: 10.1177/1591019915609169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/21/2015] [Indexed: 11/16/2022] Open
Abstract
Hidden aneurysms within occluded vessels present a challenge for interventionists because vessel perforation can lead to life-threatening complications. We present a case of middle cerebral artery ischemic stroke, refractory to thrombolysis. A direct aspiration first pass technique (ADAPT) was employed for revascularization. Following thrombectomy, an aneurysm of the occluded vessel was revealed. Despite this, the patient recovered without hemorrhagic complication. ADAPT permits the minimal insertion of endovascular devices and might be a safe procedure when hidden aneurysms are suspected.
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Affiliation(s)
- Katsunori Asai
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hajime Nakamura
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Manabu Sakaguchi
- Stroke Division, Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomohiro Kawano
- Stroke Division, Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomohiko Ozaki
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroyuki Ima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoki Kidani
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshinori Kadono
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoaki Murakami
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshiki Yoshimine
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
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Tsivgoulis G, Safouris A, Alexandrov AV. Safety of intravenous thrombolysis for acute ischemic stroke in specific conditions. Expert Opin Drug Saf 2015; 14:845-64. [DOI: 10.1517/14740338.2015.1032242] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Matsuzaki T, Yoshino A, Sakatani K, Katayama Y. Recanalization of Middle Cerebral Artery and Intracranial Aneurysm in the Same Ischemic Territory With Intravenous Administration of Recombinant Tissue Plasminogen Activator: Case Report. J Stroke Cerebrovasc Dis 2011; 20:269-72. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 12/10/2009] [Accepted: 01/05/2010] [Indexed: 10/19/2022] Open
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12
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Hashi K. Is it appropriate to exclude patients with unruptured intracranial aneurysms from the indication for intravenous thrombolysis with rt-PA for acute cerebral infarction? ACTA ACUST UNITED AC 2008. [DOI: 10.3995/jstroke.30.72] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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