Title

Endovascular coiling of a ruptured basilar apex aneurysm with associated pseudoaneurysm

UMMS Affiliation

Department of Radiology, New England Center for Stroke Research

Date

9-1-2014

Document Type

Article

Disciplines

Nervous System Diseases | Neurology | Radiology

Abstract

Acute intracranial pseudoaneurysms secondary to aneurysmal rupture are a rare entity with no clear evidence-based guidelines for treatment to our knowledge. There are numerous examples of successful treatment of pseudoaneurysms both surgically and endovascularly, the latter mainly within the anterior circulation. Risk of pseudoaneurysm rupture in the acute state during endovascular procedures with subsequent difficulty in controlling the bleeding without sacrificing the feeder artery has led to some reservation in using endovascular treatments more broadly. We report a rare case of a 52-year-old-woman who presented with acute subarachnoid hemorrhage and was found to have a ruptured 5 mm x 8 mm bi-lobulated basilar apex aneurysm on CT angiography. Digital subtraction angiography demonstrated an associated anterior pseudoaneurysm that was formed secondary to the aneurysm rupture. The true aneurysm was successfully coiled with careful avoidance of the pseudoaneurysmal sac. Pseudoaneurysms are frequently identified for the first time during digital subtraction angiography. Recognizing their presence is essential for treatment planning. Acute pseudoaneurysms associated with true aneurysmal rupture can be safely and successfully treated by endovascular coiling of the true aneurysm. Care must be taken to avoid manipulation of the pseudoaneurysmal sac during the embolization.

Rights and Permissions

Citation: J Clin Neurosci. 2014 Sep;21(9):1637-40. epub 2014 Apr 24. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Keywords

Aneurysm, Endovascular coiling, Pseudoaneurysm, Subarachnoid hemorrhage

PubMed ID

24768151