Unruptured Aneurysm: Vasospasm after Surgery and Endovascular Treatment

Arterial cerebral vasospasm in different pathological conditions other than subarachnoid haemorrhage (SAH) caused by ruptured aneurysm is uncommon. The haemodynamics-clinical consequences of such conditions makes a quick diagnosis, vital to choose the best therapeutic strategy. A 55-year-old woman presented chronic headache. Computed tomography scan revealed an image suggesting carotid aneurysm on the left which was confirmed by digital angiography in the ophthalmic segment. Programmed surgery of clipping aneurysm was carried out without complications. The patient remained without morbidity for the first 16 hours, then she developed progressive aphasia, right motor deficit and loss of consciousness. The angiography showed severe vasospasm in horizontal segments of anterior cerebral artery (A1) and middle cerebral artery (M1). Vasodilatation with topic papaverine by selective microcatheterism in A1 and M1 segments achieved clinical-radiological success in time. The patient was discharged on the seventh day, with Glasgow Coma Scale (GCS) 15/15 and slight right hemiparesis. Vasospasm pathogenesis in conditions other than SAH from ruptured aneurysm remains a scientific frontier for ongoing research. We know about the short half-life effect of papaverine and believe that the success in this particular case was accurate and definite due to the fact that the mechanism of the spasm presented no bleeding in the subarachnoid cisterns.

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Endovascular treatment of anterior cerebral artery occlusions

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017735 ◽

2021 ◽

pp. neurintsurg-2021-017735

Author(s):

Mayank Goyal ◽

Petra Cimflova ◽

Johanna Maria Ospel ◽

René Chapot

Keyword(s):

Endovascular Treatment ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Ct Perfusion ◽

Correct Diagnosis ◽

Motor Deficit ◽

Anterior Communicating Artery ◽

Routine Basis ◽

Multiphase Ct ◽

High Level

There are limited data on endovascular treatment (EVT) for anterior cerebral artery (ACA) occlusions. This review focuses on aspects related to ACA EVT: ACA anatomy, clinical and imaging findings, prognosis of ACA stroke, and ACA thrombectomy techniques. The ACA anatomy, and the regions supplied by the ACA, are highly variable; frequent anatomical variants include azygos ACA, triplicated ACA and fenestrations of the anterior communicating artery. ACA occlusions can be classified based on occlusion location, their continuity with other vessel occlusions (isolated ACA occlusion vs ACA occlusion as part of a carotid T occlusion) and etiology (primary—spontaneous ACA occlusion, vs secondary—spontaneous or iatrogenic due to clot fragmentation/migration). Symptoms of ACA stroke differ in severity and nature due to large inter-individual variations in territorial ACA blood supply. Generally, ACA strokes are severely disabling, and the typical clinical hallmark is a motor deficit of the contralateral lower extremity. Advanced imaging (CT perfusion, multiphase CT angiography) increases the likelihood of the correct diagnosis of ACA stroke and should be obtained on routine basis.Available data for ACA EVT suggest its feasibility and safety while clinical outcomes are often unfavorable with conservative management. Therefore, the potential benefit of EVT seems obvious. An optimized endovascular approach for ACA thrombectomy comprises the development and use of smaller and softer devices that can be delivered through small microcatheters with an optimized vector of force. Ultimately, generating high-level evidence for ACA EVT from randomized trials remains warranted.

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