Endovascular Management of Hemorrhagic Stroke

Significant advances in endovascular neurosurgery tools, devices, and techniques are changing the approach to the management of acute hemorrhagic stroke. The endovascular treatment of intracranial aneurysms emerged in the early 1990s with Guglielmi detachable coils, and since then, it gained rapid popularity that surpassed open surgery. Stent-assisted coiling and balloon remodeling techniques have made the treatment of wide-necked aneurysms more durable. With the introduction of flow diverters and flow disrupters, many aneurysms with complex geometrics can now be reliably managed. Arteriovenous malformations and fistulae can also benefit from endovascular therapy by embolization using n-butyl cyanoacrylate (NBCA), Onyx, polyvinyl alcohol (PVA), and coils. In this article, we describe the role of endovascular treatment for the most common causes of intracerebral and subarachnoid hemorrhages, particularly ruptured aneurysms and vascular malformations.

About an Intracranial Aneurysm Rupture During Delivery

The rupture of an intracranial aneurysm is rare during pregnancy and exceptional during delivery. When it occurs, the prognosis of two lives is engaged. We are reporting a case of a 41-year-old patient presenting with a subarachnoid hemorrhage during labor. After extraction of healthy baby through cesarian section, radiological investigations permitted to diagnose a ruptured right carotid-ophthalmic aneurysm. The patient benefited from a selective aneurysm’s exclusion by occlusion using Guglielmi detachable coils through an endovascular approach using catheterization. The immediate outcome was favorable.

Endovascular coil oclusion of spontaneous ruptured vertebral artery dissecting aneurysm

Spontaneous dissecting aneurysm of vertebral artery is known as a rare pathological condition causing a subarachnoid hemorrhage in the posterior circulation. The treatment of ruptured vertebral artery dissecting aneurysms is still an important subject of debates in the literature. We present a particular case of ruptured vertebral artery dissecting aneurysms that was treated by only endovascular Guglielmi detachable coils occlusion. A brief review of technical possibilities of treatment of these types of vascular lesions, with their advantages and disadvantages are discussed.