scholarly journals Re-treatment of an unruptured anterior communicating artery aneurysm using the new pCONus 2 device: Description of a case

2018 ◽  
Vol 24 (4) ◽  
pp. 379-382
Author(s):  
Marco Varrassi ◽  
Sergio Carducci ◽  
Aldo V Giordano ◽  
Carlo Masciocchi
Keyword(s):  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Longitudinal Axis ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Anterior Communicating Artery Aneurysm ◽  
First Case ◽  
Endovascular Approach ◽  
Unruptured Cerebral Aneurysms ◽  
Aneurysmal Neck

Endovascular approach represents today the first option in treatment of ruptured and unruptured cerebral aneurysms. Nevertheless, wide-neck bifurcation aneurysms still represent a technical challenge for endovascular treatment due to the need to protect vessels arising next to the aneurysmal neck. A variety of devices have been implemented to ensure adequate assistance for coiling of these lesions. Among these devices, the new pCONus 2 represents an evolution of the well-known pCONus; compared to the previous one in fact, it allows a degree of articulation and flexibility between the shaft and the distal part (crown), making it more suitable for treatment of aneurysms presenting an angle between the longitudinal axis of the dome and parent vessel. We report our first case using pCONus 2 in the re-treatment of an unruptured anterior communicating artery aneurysm in a 57-year-old man, showing evident recanalization two years after coiling.

scholarly journals A patient with neurofibromatosis type 1 presenting with bilateral frontal lobe infarctions following anterior communicating artery aneurysm rupture

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984115
Author(s):  
HMMTB Herath ◽  
Nilukshana Yogendranathan ◽  
Aruna Kulatunga
Keyword(s):  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Neurofibromatosis Type ◽  
Frontal Lobes ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Sri Lankan ◽  
Vascular Abnormalities ◽  
Anterior Communicating Artery Aneurysm ◽  
First Case

Neurofibromatosis is a neurocutaneous genetic condition with dysplasia of the mesodermal and ectodermal tissues. Vascular abnormalities are well recognized in neurofibromatosis and cerebral aneurysms are rarely reported in literature. Here, we present a 20-year-old Sri Lankan female presented with headache, altered personality, disinhibited behaviour, and urinary incontinence. On imaging, she was found to have infarctions of both frontal lobes and evidence of a ruptured anterior communicating artery aneurysm with a small subarachnoid haemorrhage. Another small middle cerebral artery aneurysm was also seen in the angiogram. She was managed conservatively and gradually recovered. Because aneurysms in neurofibromatosis are usually asymptomatic and as rupture of such an aneurysm is rare, regular vascular screening is not recommended to all patients with neurofibromatosis. This is the first case report in literature in which a patient with neurofibromatosis presented with infarctions of both frontal lobes due to rupture of an anterior communicating artery aneurysm.

STENT REMODELING TECHNIQUE FOR COILING OF RUPTURED WIDE-NECK CEREBRAL ANEURYSMS: CASE REPORT

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. E1007-E1008 ◽  
Author(s):  
Demetrius K. Lopes ◽  
Kalani Wells
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Acute Subarachnoid Hemorrhage ◽  
The Right ◽  
Wide Neck ◽  
Cordis Corporation

Abstract OBJECTIVE To describe a novel stent remodeling technique for the coiling of ruptured wide-neck cerebral aneurysms. CLINICAL PRESENTATION A 46-year-old man presented with acute subarachnoid hemorrhage (Hunt and Hess grade IV), intracerebral hemorrhage, and hydrocephalus. Cerebral angiography revealed a wide-neck small anterior communicating artery aneurysm. Conventional coiling was not successful because of coil instability and compromise of the dominant anterior cerebral artery. TECHNIQUE A 6-French shuttle sheath (Cook Medical, Indianapolis, IN) was advanced from a right femoral approach into the right common carotid artery. To protect the parent vessel during coiling without compromising blood flow, a Prowler Select Plus catheter (Cordis Corporation, Bridgewater, NJ) was navigated across the aneurysm neck. Subsequently, an Enterprise stent (22-mm length; Cordis Corporation) was partially deployed across the aneurysm's wide neck. It was very important to watch the distal markers of the stent and lock the stent delivery wire to the Prowler Select Plus with a hemostatic valve once the stent was halfway deployed. This maneuver was essential to prevent further deployment of the stent. The SL-10 microcatheter and Synchro 14 wire (Boston Scientific, Natick, MA) were carefully navigated to the aneurysm passing through the partially deployed stent. Coils were then delivered to the aneurysm using the stent as a scaffold. After coiling, the SL-10 microcatheter was removed and the stent was recaptured into the Prowler Select Plus catheter. During the recapture, there was initial resistance. This was easily overcome after deploying the stent a little more before resheathing. During the procedure, the patient received 2000 U of heparin after the first coil was detached in the aneurysm. CONCLUSION The stent remodeling technique is a novel endovascular technique that can be used to treat ruptured wide-neck aneurysms and maintain patency of parent vessels, avoiding the use of antiplatelet therapy in acute subarachnoid hemorrhage.

scholarly journals Orbitozygomatic Craniotomy for Giant Anterior Communicating Artery Aneurysm: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (1) ◽  
pp. E5-E6
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Parent Artery ◽  
Aneurysm Neck ◽  
Anterior Communicating Artery Aneurysm ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Vessel Patency ◽  
Aneurysmal Neck

Abstract Giant intracranial aneurysms pose a significant surgical challenge because of the associated difficulty in achieving adequate visualization of the parent artery and aneurysm neck. This patient had an incidentally identified giant anterior communicating artery aneurysm. An orbitozygomatic craniotomy was performed for aneurysm exposure and aneurysmal neck dissection. Aneurysm dome opening and thrombectomy was performed to debulk the aneurysmal mass, which facilitated subsequent aneurysmal neck visualization. Sequential utilization of temporary clips of the bilateral A1 and bilateral A2 vessels reduced hemorrhage during thrombectomy. Multiple permanent clips were applied along the dissected aneurysm neck to permit occlusion. A small fracture of the aneurysm neck was identified, and cotton was applied with subsequent tamponade utilizing a fenestrated clip to maintain hemostasis. Indocyanine green fluoroscopy was used to verify parent and distant vessel patency. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Coil Embolization for Ruptured Cerebral Aneurysms of 2×3 mm Diameter

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 97-100 ◽  
Author(s):  
O. Tone ◽  
H. Tomita ◽  
M. Tamaki ◽  
H. Akimoto ◽  
K. Shigeta ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Three Dimensional ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
First Case ◽  
Detachable Coils ◽  
The Mean ◽  
Aneurysmal Neck ◽  
Small Aneurysms ◽  
Made In

Small ruptured cerebral aneurysms, such as those of 2×3 mm diameter, are considered to be difficult to embolize by detachable coils because of the risk of procedural perforation of the aneurysms. We have treated these small aneurysms and report the techniques and pitfalls of these embolizations. Twenty-four patients with ruptured cerebral aneurysms of 2×3 mm diameter were intended for treatment by coil embolization. Before coil embolization, three-dimensional digital subtraction angiography was performed, and the simulation of the volume embolization ratio (VER) was performed in all patients, except for the first basilar artery aneurysm patient. The tip of the microcatheter was steam-shaped several times and was placed on the neck of the aneurysm. A balloon neck remodeling technique was used for two aneurysms. GDC 10 softs and soft SRs were used for the first ten aneurysms, and Ultrasofts were used for the last eleven aneurysms. Out of twenty-four aneurysm embolizations, we aborted the procedure in three cases, because of a failure in catheterization; we performed clipping surgery for these cases. For the first case of a basilar tip aneurysm, the aneurysm was perforated, due to the use of too long a coil and the insertion of the tip of the microcatheter into the aneurysmal dome. Minor infarction occurred in one patient. The mean VER was 33.9%, and two aneurysms recanalized, and out of these one needed a second embolization. Six months postoperatively, 81% of patients had made in a good recovery or had a moderate disability. We recommend the following techniques to embolize aneurysms of 2×3 mm diameter: the tip of the microcatheter should be stabilized on the aneurysmal neck by steam shaping of the microcatheter, GDC 10 soft and Ultrasoft should be selected for use, and the simulation of the VER should be performed before embolization to select coils of a suitable length.

Hemodynamics Analysis of Several Stent Treatments of a Patient Specific Anterior Communicating Artery Aneurysm

2012 ◽  
Author(s):  
S. Cito ◽  
J. Pallarés ◽  
A. Vernet ◽  
A. J. Geers ◽  
I. Cuesta
Keyword(s):  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
The Other ◽  
Patient Specific ◽  
Anterior Communicating Artery ◽  
Flow Conditions ◽  
Real Patient ◽  
Open Cell ◽  
Anterior Communicating Artery Aneurysm ◽  
Closed Cell

CFD predictions of the flow in cerebral aneurysms can help to analyze the mechanisms of growth and rupture and the degree of stress for a given flow conditions and to compare and to propose different stenting treatments. In this work we simulated the flow in a model of cerebral aneurysms of a real patient in six different conditions. One case corresponds to the flow conditions in the aneurysm without treatment and the other five cases correspond to different options or strategies of treatment with open cell stents (OCS) and closed cell stents (CCS) to hold the coil. The aneurysm is located in the anterior communicating artery (AComA). The effect of the treatment on the hemodynamics is quantified and reported.

Thrombolysis and Mechanical Fragmentation to Treat Massive Pulmonary Embolism in a Patient with an Anterior Communicating Artery Aneurysm

2003 ◽  
Vol 10 (2) ◽  
pp. 332-335 ◽  
Author(s):  
Ramazan Kutlu ◽  
Alpay Alkan ◽  
Ayhan Kocak ◽  
Kaya Sarac
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Arteries ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Recombinant Tissue Plasminogen Activator ◽  
Massive Pulmonary Embolism ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysm ◽  
The Right ◽  
Mechanical Fragmentation

Purpose: To describe successful management of massive pulmonary embolism suffered by a patient with an unsecured intracranial aneurysm. Case Report: An anterior communicating artery aneurysm was found 10 days after a 50-year-old woman was admitted to the intensive care unit with subarachnoid hemorrhage. The patient developed severe acute dyspnea before planned surgery; imaging demonstrated thrombus in the right and left pulmonary arteries. Heparin was contraindicated, so an emergent coil embolization procedure was undertaken. In the same session, recombinant tissue plasminogen activator was administered directly into the thrombus. After 2 hours of thrombolysis and intermittent mechanical fragmentation, lung perfusion improved, and the patient's symptoms abated. Conclusions: Mechanical fragmentation together with fibrinolytic agent administration is a safe and effective treatment for pulmonary embolism after securing cerebral aneurysms.

Multiple ruptured cerebral aneurysms in a child with Takayasu arteritis

2008 ◽  
Vol 1 (1) ◽  
pp. 83-87 ◽  
Author(s):  
Suresh N. Magge ◽  
H. Isaac Chen ◽  
Michael F. Stiefel ◽  
Linda Ernst ◽  
Ann Marie Cahill ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysm ◽  
Takayasu Arteritis ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Rare Presentation ◽  
Anterior Communicating Artery Aneurysm ◽  
Clip Application

✓The authors report the case of an 18-month-old girl who presented with a ruptured anterior communicating artery aneurysm, and who was later diagnosed with Takayasu arteritis. Her initial aneurysm was successfully treated with clip application. However, over a 6-month period she had multiple ruptures from new and rapidly recurring aneurysms adjacent to the clips. These aneurysms were treated with repeated craniotomy and clip application and then with endovascular coil placement. Aneurysmal subarachnoid hemorrhage is a rare presentation of Takayasu arteritis. To the authors' knowledge, this is the youngest reported patient with Takayasu arteritis to present with a ruptured cerebral aneurysm.

Preoperative Evaluation of Unruptured Cerebral Aneurysms by Fast Imaging Employing Steady-State Acquisition Image

Neurosurgery ◽  
2011 ◽  
Vol 69 (2) ◽  
pp. 412-420 ◽  
Author(s):  
Toshikazu Kimura ◽  
Akio Morita ◽  
Ichiro Shirouzu ◽  
Shigeo Sora
Keyword(s):  
Steady State ◽  
Magnetic Resonance ◽  
Persistent Vegetative State ◽  
Cranial Nerves ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Posterior Communicating Artery ◽  
Fast Imaging ◽  
Anterior Communicating Artery ◽  
Unruptured Cerebral Aneurysms

Abstract BACKGROUND: In aneurysm surgery, understanding the microanatomy around the aneurysm such as perforating arteries and cranial nerves is mandatory. OBJECTIVE: To assess the usefulness in determining the microanatomy around the cerebral aneurysms by the use of fast imaging employing steady-state acquisition (FIESTA) images of magnetic resonance imaging preoperatively, in addition to computed tomography and digital subtraction angiography. METHODS: Between October 2006 and June 2009, 123 patients with 140 unruptured cerebral aneurysms were treated in our institution. Eighty-two patients were assessed with FIESTA by the operators on the workstation of the magnetic resonance image before surgical clipping of the aneurysms. The small vessels and cranial nerves were confirmed intraoperatively before or after obliteration of the aneurysms. RESULTS: Sensitivities and specificities of FIESTA imaging were 100% in detecting hypothalamic artery around anterior communicating artery aneurysms, oculomotor nerve attachment to the posterior communicating artery aneurysm domes, and anterior choroidal artery adhesion to the posterior communicating artery aneurysms. This technique was also useful for predicting adhesion between the aneurysm and adjacent main trunks or perforators. Although the specificity was 100%, sensitivity was 56% in detecting vessel adhesion around the middle cerebral aneurysms. This technique can provide limited information in large aneurysms or aneurysms located in minimal cerebrospinal fluid space. The overall outcomes of the patients included 120 excellent recoveries, 1 moderate deficit, 1 severe deficit, and 1 persistent vegetative state according to the Glasgow Outcome Scale. CONCLUSION: By giving information on the minute anatomical structure around the aneurysm, FIESTA can contribute to thorough preoperative evaluations of cerebral aneurysms.

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