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Middle Cerebral Artery Bifurcation Aneurysm: A Ruptured Wide-Necked Aneurysm Treated with Comaneci-Assisted Coiling

  • Stanimir Sirakov
  • Alexander Sirakov
  • Ivan Lylyk
  • Carlos Bleise
  • Rene Viso
  • Pedro Lylyk
Living reference work entry

Abstract

A 52-year-old man presented to the hospital the day after the onset of a thunderclap headache. He was found to have a Fisher grade IV subarachnoid hemorrhage (SAH) and an intraparenchymal hematoma adjacent to the Sylvian fissure secondary to a ruptured aneurysm involving the bifurcation of the right middle cerebral artery (MCA). Angiographic examination confirmed the diagnosis of a wide-necked aneurysm incorporating both the superior and inferior efferent MCA branches. The presence of an acute intracranial hemorrhage in combination with the ruptured, wide-necked aneurysm would have made conventional endovascular techniques challenging. Instead, the patient underwent successful coil embolization, using a Comaneci temporary neck-bridging device. In this case, we present a novel temporary neck-bridging technique and the feasibility of using this for the treatment of ruptured intracranial aneurysms without dual antiplatelet therapy. This case concerns a fully re-sheathable, temporary neck-bridging device which enabled a ruptured wide-necked MCA aneurysm to be successfully coiled before the device was withdrawn. This technique obviates the need for dual antiplatelet therapy, making it particularly suitable for use in cases of acute subarachnoid hemorrhage secondary to aneurysm rupture. The successful use of the Comaneci device to facilitate coil occlusion of a recently ruptured, wide-necked aneurysm is the main topic of this chapter.

Keywords

Middle cerebral artery Wide-necked aneurysm Temporary neck bridging Comaneci device 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Stanimir Sirakov
    • 1
  • Alexander Sirakov
    • 1
  • Ivan Lylyk
    • 2
  • Carlos Bleise
    • 2
  • Rene Viso
    • 2
  • Pedro Lylyk
    • 2
  1. 1.University Hospital St. Ivan RilskiSofiaBulgaria
  2. 2.Clinica La Sagrada Familia, ENERIBuenos AiresArgentina

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