Abstract
A 61-year-old female patient presented with a large, incidental aneurysm of the supraclinoid segment of the left internal carotid artery (ICA). The patient was treated with flow diverter (FD)-assisted coil occlusion. The procedure was performed without any complications. Three days after the treatment, the patient presented with a severe headache, anisocoria, and rapid loss of consciousness. An MRI examination revealed an acute subarachnoid and intraventricular hemorrhage (SAH/IVH) with occlusive hydrocephalus. External ventricular drainage (EVD) was put in place. Afterwards, a diagnostic angiography (DSA) revealed persistent perfusion of the aneurysmal neck as well as extravasation at the dome of the aneurysm, consistent with the site of the aneurysm rupture. The patient developed progressive hydrocephalus which was treated by inserting a second EVD and with intraventricular thrombolysis. Three days later, a second DSA was performed. The perfusion of the aneurysm neck remained unchanged, while the aneurysm fundus remained thrombosed. In the further course, proper absorption of the SAH and IVH was observed. After 3 weeks, the patient was transferred for rehabilitation with a modified ranking score 5, as she was comatose and non-responsive. Due to the sequelae of the IVH, the patient passed away 40 days after the endovascular treatment. The phenomenon of acute aneurysm rupture after flow diversion treatment is the main topic of this chapter.
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Hellstern, V., Aguilar Pérez, M., AlMatter, M., Bäzner, H., Henkes, H. (2020). Supraclinoid Internal Carotid Artery Aneurysm: Acute Subarachnoid and Intraventricular Hemorrhage due to Aneurysm Rupture After Flow Diverter-Assisted Coil Occlusion. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_151-1
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DOI: https://doi.org/10.1007/978-3-319-70267-4_151-1
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