Intravenous abciximab for parent vessel thrombus during basilar apex aneurysm coil embolization: case report and literature review

BACKGROUND: Parent vessel thrombus formation is a serious complication of intracranial aneurysm embolization. The management of this issue is controversial. Abciximab, a potent platelet inhibitor, has been shown to have thrombolytic effects during coronary interventions. A small number of cases have demonstrated its potential application in neuroendovascular procedures. We review the literature on the management of parent vessel thrombosis during aneurysm coil embolization and report our successful experience with the use of IV abciximab to treat parent vessel thrombus formation related to coil embolization of a basilar apex aneurysm. CASE DESCRIPTION: A 45-year-old man presented to our center with an incidental basilar apex aneurysm. After being informed of the surgical and endovascular treatment options, he elected to undergo coil embolization of the aneurysm. During the procedure, acute thrombus was noted in the left P1 segment of the posterior cerebral artery. IV abciximab was administered, and an angiogram the following day showed complete dissolution of the clot. The patient had no neurologic sequelae. CONCLUSIONS: IV abciximab appears to be an effective option in the management of acute parent vessel thrombus encountered during coil embolization of unruptured aneurysms. Sufficient data are lacking regarding its use in the setting of a ruptured aneurysm.     

The application of near-infrared oximetry to cerebral monitoring during aneurysm embolization: a comparison with intraprocedural angiography

Near-infrared spectroscopy (NIRS) has been used to monitor regional cerebral oxygen saturation (rSO2) in patients at risk of cerebral desaturation during surgical and neurointerventional procedures. However, the quantitative capabilities of the method have been questioned, as has its validation compared with jugular bulb oximetry. Here, we compare NIRS data acquired during coil embolization procedures with incidence of vasospasm as detected from angiography. Thirty-two subarachnoid hemorrhage patients underwent embolization. Bilateral SomaSensor strips (Invos 4100, Somanetics) were affixed to the forehead at constant anatomic positions, avoiding frontal sinuses and scalp hair. Mean arterial pressure, SaO2, end-tidal pCO2, temperature and Hb were held within a narrow range during the procedure. Ipsilateral angiography was performed every 10 to 15 minutes. An independent neuroradiologist classified any vasospasm in the parent vessel as mild (25% baseline), moderate (50%), severe (75%), or total (100%). Of all, 15/32 (46.9%) patients developed spasm; in 2 it was severe or total. There was no significant association between World Federation of Neurological Surgeons grade and baseline rSO2 signal (either ipsilateral or contralateral to the side of the aneurysm) (P=0.598). There was no significant association between side of aneurysm and baseline rSO2 signal (P=0.243). However, episodes of angiographic spasm were strongly associated with reduction in trend ipsilateral NIRS signal (P<0.001); furthermore, the degree of spasm (especially more than 75% vessel diameter reduction) was associated with a greater reduction in same-side NIRS signal (P<0.001) (2-level random effects regression model, Stata 8.2, Stata Corp, TX). NIRS may have a useful role to play in the detection of cerebral desaturation secondary to vasospasm during neuroendovascular procedures.     

Endosaccular embolization of an intrasellar aneurysm with hypopituitarism: case report

An 81-year-old male presented with weight loss and hyponatremia. A baseline endocrinological examination revealed anterior pituitary dysfunction. A computed tomography and MRI revealed a large, unruptured intrasellar aneurysm protruding from the right internal carotid artery and pushing the pituitary stalk leftward. The patient developed polyuria and polydipsia from 10 days after commencing corticosteroid supplementation and was diagnosed with partial central diabetes insipidus (DI). Balloon assisted endosaccular embolization was performed about one month after the posterior pituitary dysfunction was identified. The unruptured aneurysm was successfully embolized with Guglielmi detachable coils (GDCs) without narrowing of the parent vessel. DI resolved completely and the posterior pituitary dysfunction improved soon after endosaccular embolization. The remission of DI after coil embolization suggested that the DI might have been induced by the progressive mass effect of the aneurysm rather than by the steroid. An endocrinological evaluation and cerebral angiography confirmed partial recovery of anterior pituitary dysfunction and almost complete obliteration of the aneurysm, respectively at 1 year after the operation. We report a case of hypopituitarism secondary to the large intrasellar aneurysm. This aneurysm was embolized with GDCs, resulting in partial recovery of anterior pituitary dysfunction and complete recovery of posterior pituitary dysfunction.     

颅内动脉瘤弹簧圈栓塞治疗术中动脉瘤再破裂的防治

目的颅内动脉瘤在弹簧圈栓塞过程中发生破裂是最可怕的术中并发症之一，本文探讨处理、预防这一并发症的初步经验。方法2002年4月-2006年12月，共有153例患有颅内动脉瘤的患者在我院接受了可脱卸弹簧圈栓塞治疗，其中141例患者曾有过动脉瘤破裂引起蛛网膜下腔出血史。5例有动脉瘤破裂出血史的患者术中再次发生动脉瘤破裂。术中动脉瘤再破裂时，常规使用鱼精蛋白中和肝素，并设法用弹簧圈尽快填塞动脉瘤腔。微导丝引起动脉瘤破裂时，尽量保持微导丝不动，微导管尽快送到瘤腔中进行填塞治疗。若微导管引起破裂而微导管头端位于瘤壁外蛛网膜下腔时，微导管且勿退入瘤腔内，应将弹簧圈经微导管送入蛛网膜下腔一部分后，再将微导管头撤入瘤腔内，继续弹簧圈填塞。若弹簧圈引起破裂，要将弹簧圈完全或部分送出去，将破裂口堵住后，调整微导管头端位置继续弹簧圈填塞。结果在接受动脉瘤栓塞治疗的153例患者中，141例曾有过动脉瘤破裂引起蛛网膜下腔出血，治疗中5例发生了术中再破裂，占动脉瘤破裂引起蛛网膜下腔出血的3．5％，总发生率为3．3％。1例破裂由导丝引起，1例由微导管引起，1例由弹簧圈过度填塞引起，弹簧圈穿孔1例，其余1例由微导管和弹簧圈共同引起。2例死亡，死亡率占术中破裂的40％，占总例数的1．3％；1例患者出院时遗留有右下肢瘫痪，其余2例患者无残留神经系统并发症。结论动脉瘤栓塞术中动脉瘤的再破裂是一少见、威胁生命但又不可避免的事件。应该立即采取妥善措施以挽救患者生命、改善预后、降低可怕并发症的发生。如处理恰当，多数术中动脉瘤破裂的患者能够存活，无后遗症。     

Catheter embolization of an hepatic artery aneurysm: a case report

Hepatic artery aneurysms (HAAs) are considered rare. The great improvement in the diagnosis of vascular diseases and the increasing incidence of atherosclerosis have resulted in a wider recognition of these pathologies. Differently from other splanchnic locations, HAAs have a high risk of rupture so that an aggressive treatment is required. Different therapeutic options are currently available: simple ligation of the artery, aneurysm excision with vascular reconstruction, and transcatheter embolization. We describe the usefulness of transcatheter arterial embolization of an 8 cm hepatic artery aneurysm incidentally found on an abdominal computed tomography (CT) scan in an asymptomatic patient.     

经皮椎体成形术后肾动脉栓塞1例报道

<正>经皮椎体成形术(percutaneous vertebroplasty,PVP)是目前治疗骨质疏松性椎体压缩骨折(osteoporotic vertebra compressed fracture,OVCF)常用的手术方式,但该术式也存在一些并发症,其中最严重、最常见的为骨水泥渗漏。一旦发生骨水泥渗漏,根据渗漏部位、剂量,可产生不同的后果。我院收治了1例患者,在行T11椎体PVP手术时,骨水泥渗漏进入腹主动脉,继而进入肾动脉,导致肾动脉栓塞,报道如下。患者女性,70岁。因"挑水致腰背部疼痛、活动受限3d"于2019年8月7日入院。患者于3d前在家挑水后出现胸腰背部疼痛,活动障碍,翻身及坐起时疼痛明显,双下     

Angioplasty and coiling of ruptured aneurysm with symptomatic vasospasm: technical case report

BACKGROUND: Treating a ruptured cerebral aneurysm during symptomatic vasospasm is very difficult. We describe the successful endovascular treatment of such a case and discuss its efficacy. CASE PRESENTATION: A 34-year-old man had a sudden onset of severe headache. One week later, he was referred to our institute with gradually progressing right hemiparesis and global aphasia. Cerebral angiography demonstrated severe vasospasm of the left internal carotid artery system and an anterior communicating artery aneurysm. With the patient under general anesthesia, 90% occlusion of the aneurysm was achieved with detachable coils after successful dilatation of the spastic vessels. The patient had an uneventful postoperative course and his neurologic symptoms were improved. Seven months after the endovascular treatment, the enlarged neck remnant of the aneurysm was successfully clipped without difficulty. CONCLUSION: The simultaneous treatment of a ruptured aneurysm and vasospasm with percutaneous transluminal angioplasty and coils can produce a better outcome for the patient.     

Selective embolization of splenic artery aneurysm – case report

Summary BACKGROUND: Embolization of visceral artery aneurysms has been increasingly accepted as a beneficial alternative to surgery. METHODS: The aim of this case report was to evaluate the feasibility of the endovascular therapy of a saccular aneurysm of the splenic artery at its first bifurcation. We approached the aneurysm with a supraselective catheter embolization using coils. RESULTS: After an interval of 4 weeks, we found a residual perfusion (0.3 by 0.6 mm) within the former neck in the control angiography. A repeat supraselective embolization was not favored because of catheter-induced vascular spasms of the splenic artery. A further 8 weeks later, control angiography revealed thrombosis of the previously diagnosed aneurysmatic sac, confirmed only minor residual flow through the thrombosed neck of the former aneurysm, and indicated sustained spleen blood supply as further revealed in later duplex ultrasonography follow-up. CONCLUSIONS: Selective coil embolization as first-line therapy to treat saccular splenic artery aneurysm is feasible.     

Combined endovascular stent implantation and coil embolization for the treatment of a vertebro-basilar fusiform aneurysm: technical case report

We describe a case of the combined application of endovascular stent implantation and Guglielmi detachable coil packing for the treatment of a vertebro-basilar fusiform aneurysm and review the literature on stent placement to treat cerebral aneurysms. A 70-year-old female presented with an acute headache from subarachnoid hemorrhage. A fusiform aneurysm with a broad-based neck and dome, measuring 15 mm, involving the union of the vertebral arteries and the proximal basilar artery was demonstrated on cerebral angiography. The aneurysm was judged to be inoperable and treated conservatively. Twelve days later the patient was transferred to our hospital for endovascular therapy. An intravascular stent (MultiLink) was placed across the base of the aneurysm through the right vertebral artery. After this, coil placement in the aneurysm around the stent was performed via a microcatheter guided from the left vertebral artery. After that a microcatheter was guided from the right vertebral artery through the interstices of the stent into the aneurysm, and additional coils were placed. Final angiography showed subtotal occlusion of the aneurysm and excellent blood flow of the parent artery through the stent. There were no new neurological deficits. Neither rerupture nor ischemic event has occurred. The use of stents provides another treatment for managing the difficult entity of intracranial aneurysms.     

Ruptured cerebral aneurysm associated with aortitis syndrome: a case report

In rare occasions, patients with aortitis syndrome have cerebral aneurysms and only seven cases have been reported so far. A case of aortitis syndrome complicated with basilar bifurcation aneurysm is reported. A 58-year-old woman, who had been hypertensive for 20 years and was diagnosed as pulseless disease 10 years ago, suddenly had severe headache and became unconscious on Feb. 17, 1983. Spinal tap performed 3 days after the onset demonstrated bloody cerebrospinal fluid. She was referred to our clinic 8 days following the ictus of subarachnoid hemorrhage. On admission, she was drowsy and had headache, neck stiffness, disorientation and left hemiparesis. Pulsation of the left common carotid and left radial artery was unpalpable. Angiography through the intraaortic catheter revealed occlusion of the left common and left subclavian arteries at their origin, confirming aortitis syndrome. Through the patent right vertebral artery, basilar artery was visualized and an aneurysm at the basilar bifurcation was noted. Seven cases reported in the literature were reviewed.     

Intra-procedural aneurysm rupture treated with n-butyl cyanoacrylate embolization: technical note

A case is described of utilizing liquid polymer and stent placement to treat a procedural rupture of intracranial aneurysm during coil embolization. Although this technique is challenging, it seals the rupture immediately and can be used when additional coil placement is not possible.     

Unruptured carotid-duplicated middle cerebral artery aneurysm: case report

We demonstrate the first case with unruptured carotid-duplicated middle cerebral artery (IC-Dup MCA) aneurysm combined with ruptured opposite carotid aneurysm. Eleven IC-Dup MCA aneurysm reported until now had all ruptured. It is noteworthy that 8 patients of the 11 were Japanese.