Intra-aneurysmal GDC embolization followed by intrathecal tPA administration for poor-grade basilar tip aneurysm.
BACKGROUND
This 42-year-old male presented with subarachnoid hemorrhage of Hunt and Kosnik Grade IV, complicated by neurogenic pulmonary edema, prolongation of the electrocardiographic Q-Q interval, and acute renal failure.


METHODS
Surgical clipping was not indicated, so intra-aneurysmal embolization using Guglielmi detachable coils (GDCs) was performed followed by intrathecal infusion of tissue-type plasminogen activator (tPA) via spinal drainage.


RESULTS
The patient made a complete recovery 2 1/2 months later except for partial third cranial nerve palsy.


CONCLUSIONS
Intra-aneurysmal GDC embolization followed by intrathecal tPA via spinal drainage is an excellent method for treating aneurysms that are difficult to treat surgically.
Ezura
M
M
Department of Intravascular Neurosurgery, Kohnan Hospital, Sendai, Japan.
Takahashi
A
A
Ogasawara
K
K
Yoshimoto
T
T
D000328:Adult; D001488:Basilar Artery / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D006801:Humans; D007278:Injections, Spinal; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D010960:Plasminogen Activators / Q000008:administration & dosage*; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed
D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator