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Basilar Artery Bifurcation Aneurysm: Acute SAH, Ruptured Wide Neck Basilar Bifurcation Aneurysm, Medina and Coil Occlusion Assisted by pCONus2, Early Interruption of Antiaggregation Without Sequelae

Living reference work entry

Abstract

A large, wide necked ruptured aneurysm of the basilar artery bifurcation was treated by endovascular Medina- (Medtronic) and coil occlusion assisted by pCONus2 (phenox). This combination of implants allowed the interruption of the blood circulation inside the aneurysm despite a neck width of 9 mm. The procedure has been carried out under dual antiaggregation with acetylsalicylic acid (ASA; Aspirin i.v., Bayer Vital) and ticagrelor (Brilique, AstraZeneca). Immediately after the treatment, a minor perfusion of the aneurysm dome was still visible, which had ceased three days later. The administration of ticagrelor had been inadvertently stopped one month after the treatment, while the administration of 100 mg ASA PO daily was continued. A thromboembolic complication did not occur. The patient, whose clinical condition was initially Hunt and Hess III, recovered significantly within two months in the hospital and having two months of rehabilitation. Angiographic follow-up three and 12 months after the treatment confirmed a stable obliteration of the aneurysm. The use of pCONus2 and Medina is the main topic of this report.

Keywords

Basilar artery bifurcation aneurysm SAH pCONus2 Medina Antiaggregation 

References

  1. Aguilar Perez M, Bhogal P, Martinez Moreno R, Bäzner H, Ganslandt O, Henkes H. The medina embolic device: early clinical experience from a single center. J Neurointerv Surg. 2017;9(1):77–87.  https://doi.org/10.1136/neurintsurg-2016-012539.CrossRefPubMedGoogle Scholar
  2. Bhogal P, Brouwer PA, Yeo L, Svensson M, Söderman M. The medina embolic device: Karolinska experience. Interv Neuroradiol. 2017;  https://doi.org/10.1177/1591019917733125.
  3. Cho YD, Jeon JP, Yoo DH, Cho WS, Kang HS, Kim JE, Han MH. Growth-related major recanalization of coiled aneurysms: incidence and risk factors. Neurosurgery. 2017.  https://doi.org/10.1093/neuros/nyx176.
  4. Fiorella D, Molyneux A, Coon A, Szikora I, Saatci I, Baltacioglu F, Sultan A, Arthur A, WEB-IT Study Investigators. Demographic, procedural and 30-day safety results from the WEB intra-saccular therapy study (WEB-IT). J Neurointerv Surg. 2017;pii: neurintsurg-2016-012841.  https://doi.org/10.1136/neurintsurg-2016-012841.
  5. Lubicz B, Morais R, Alghamdi F, Mine B, Collignon L, Eker OF. The pCONus device for the endovascular treatment of wide neck bifurcation aneurysms. J Neurointerv Surg. 2016;8(9):940–4.  https://doi.org/10.1136/neurintsurg-2015-011898.CrossRefPubMedGoogle Scholar
  6. Marotta TR, Riina HA, McDougall I, Ricci DR, Killer-Oberpfalzer M. Physiological remodeling of bifurcation aneurysms: preclinical results of the eCLIPs device. J Neurosurg. 2017;1–7.  https://doi.org/10.3171/2016.10.JNS162024.
  7. Mühl-Benninghaus R, Simgen A, Reith W, Yilmaz U. The Barrel stent: new treatment option for stent-assisted coiling of wide-necked bifurcation aneurysms-results of a single-center study. J Neurointerv Surg. 2016;pii: neurintsurg-2016-012718.  https://doi.org/10.1136/neurintsurg-2016-012718.
  8. Mukherjee S, Chandran A, Gopinathan A, Putharan M, Goddard T, Eldridge PR, Patankar T, Nahser HC. PulseRider-assisted treatment of wide-necked intracranial bifurcation aneurysms: safety and feasibility study. J Neurosurg. 2017;127(1):61–8.  https://doi.org/10.3171/2016.2.JNS152334.CrossRefPubMedGoogle Scholar
  9. Pérez MA, Bhogal P, Moreno RM, Wendl C, Bäzner H, Ganslandt O, Henkes H. Use of the pCONus as an adjunct to coil embolization of acutely ruptured aneurysms. J Neurointerv Surg. 2017;9(1):39–44.  https://doi.org/10.1136/neurintsurg-2016-012508.CrossRefPubMedGoogle Scholar
  10. Signorelli F, Sturiale CL, La Rocca G, Albanese A, D’Argento F, Mattogno P, Puca A, Visocchi M, Marchese E, Pedicelli A. Giant basilar artery aneurysm involving the origin of bilateral posterior cerebral and superior cerebellar arteries: neck reconstruction with pCONus-assisted coiling. Acta Neurochir Suppl. 2017;124:129–34.  https://doi.org/10.1007/978-3-319-39546-3_20.CrossRefPubMedGoogle Scholar
  11. Sourour NA, Vande Perre S, Maria FD, Papagiannaki C, Gabrieli J, Pistocchi S, Bartolini B, Degos V, Carpentier A, Chiras J, Clarençon F. Medina® embolization device for the treatment of intracranial aneurysms: safety and angiographic effectiveness at 6 months. Neurosurgery. 2017.  https://doi.org/10.1093/neuros/nyx161.
  12. Spiotta AM, Derdeyn CP, Tateshima S, Mocco J, Crowley RW, Liu KC, Jensen L, Ebersole K, Reeves A, Lopes DK, Hanel RA, Sauvageau E, Duckwiler G, Siddiqui A, Levy E, Puri A, Pride L, Novakovic R, Chaudry MI, Turner RD, Turk AS. Results of the ANSWER trial using the PulseRider for the treatment of broad-necked, bifurcation aneurysms. Neurosurgery. 2017;81(1):56–65.  https://doi.org/10.1093/neuros/nyx085.CrossRefPubMedGoogle Scholar
  13. Tsurumi A, Tsurumi Y, Negoro M, Tsugane S, Ryuge M, Susaki N, Fukuoka T, Miyachi S. Delayed rupture of a basilar artery aneurysm treated with coils: case report and review of the literature. J Neuroradiol. 2013;40(1):54–61.  https://doi.org/10.1016/j.neurad.2012.08.005.CrossRefPubMedGoogle Scholar
  14. Ulfert C, Pfaff J, Schönenberger S, Bösel J, Herweh C, Pham M, Bendszus M, Möhlenbruch M. The pCONus device in treatment of wide-necked aneurysms: technical and midterm clinical and angiographic results. Clin Neuroradiol. 2016;1–8.  https://doi.org/10.1007/s00062-016-0542-z

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Institut für Nuklearmedizin und RadiologieKlinikum BraunschweigBraunschweigGermany
  2. 2.Neuroradiologische Klinik, NeurozentrumKlinikum StuttgartStuttgartGermany

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