[Ruptured giant thrombosed aneurysm at the internal carotid artery successfully treated with endovascular internal trapping following emergent balloon occlusion test: a case report].
The authors report a case of ruptured giant thrombosed aneurysm successfully treated with endovascular internal trapping following emergent balloon occlusion test (BOT), and discuss its clinical implications regarding emergent BOT. A 41-year-old female showing massive epistaxis was referred to our institute for the treatment of a giant aneurysm. Computed tomography and digital subtraction angiography revealed a giant thrombosed aneurysm located at the petrous portion of the right internal carotid artery with an erosion of the petrous bone. Emergent BOT was performed under the monitoring of regional oxygen saturation of the brain (rSO₂) and stump pressure as well as neurological changes and confirmed tolerance for permanent internal artery occlusion with a little change of rSO₂ and stump pressure. Endovascular internal trapping was performed with detachable coils and the postoperative course was uneventful. Magnetic resonance imaging showed a decrease in the size of the aneurysm three month after the treatment, and the aneurysm got organized four years later. For ruptured aneurysms, emergent BOT is sometimes difficult to perform due the neurological deterioration or inability to prepare radioisotope for single photon computed tomography. Nevertheless, monitoring of rSO₂ and stump pressure as well as neurological changes can be of help for decision making concerning the treatment strategy. Endovascular treatment following BOT is a feasible and life-saving approach for emergent management of ruptured internal carotid artery aneurysms presented with massive epistaxis.
Department of Neurosurgery, Nagasaki University School of Medicine, Japan.
Tomonori
T
Takeshita
Nobutaka
N
Horie
Gohei
G
So
Kenta
K
Ujifuku
Kentaro
K
Hayashi
Minoru
M
Morikawa
Kazuhiko
K
Suyama
Izumi
I
Nagata
D000328:Adult; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D021721:Balloon Occlusion / Q000379:methods; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002343:Carotid Artery, Internal; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D013927:Thrombosis; D014057:Tomography, X-Ray Computed