Paraophthalmic Internal Carotid Artery Aneurysm: Spontaneous Subarachnoid Hemorrhage, Blood Blister Aneurysm, Flow Diverter Treatment During the Acute Phase
A 48-year-old female patient presented with a headache and nuchal stiffness which had been present for a week and with paresthesia of the left side which had been present for a day. The patient had been treated for a paraophthalmic aneurysm of the left ICA with flow diversion 12 months prior. Non-contrast cranial CT (NCCT) was within normal limits. Lumbar puncture showed xanthrochromic cerebrospinal fluid (CSF) in accordance with a recent subarachnoid hemorrhage (SAH). On day seven after the clinical onset, a DSA revealed a blister aneurysm of the paraophthalmic segment of the right internal carotid artery (ICA), directed cranially and with a neck diameter of 2.5 mm. This blister aneurysm was considered to be the most likely source of the SAH. Dual platelet function inhibition was induced during the following endovascular procedure using acetylsalicylic acid (ASA), ticagrelor, and eptifibatide. A p64 flow diverter stent was implanted into the paraophthalmic segment of the right ICA, covering the blister aneurysm. This procedure was well tolerated and a follow-up DSA three months later confirmed the blister aneurysm had been obliterated. The flow diverter treatment of ruptured blister aneurysms of the anterior circulation during the acute post-SAH phase is the main topic of this chapter.
KeywordsBlister aneurysm SAH Flow diversion In-stent stenosis Anterior circulation p64
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