Endovascular coiling of a ruptured basilar apex aneurysm with associated pseudoaneurysm.
Acute intracranial pseudoaneurysms secondary to aneurysmal rupture are a rare entity with no clear evidence-based guidelines for treatment to our knowledge. There are numerous examples of successful treatment of pseudoaneurysms both surgically and endovascularly, the latter mainly within the anterior circulation. Risk of pseudoaneurysm rupture in the acute state during endovascular procedures with subsequent difficulty in controlling the bleeding without sacrificing the feeder artery has led to some reservation in using endovascular treatments more broadly. We report a rare case of a 52-year-old-woman who presented with acute subarachnoid hemorrhage and was found to have a ruptured 5 mm × 8 mm bi-lobulated basilar apex aneurysm on CT angiography. Digital subtraction angiography demonstrated an associated anterior pseudoaneurysm that was formed secondary to the aneurysm rupture. The true aneurysm was successfully coiled with careful avoidance of the pseudoaneurysmal sac. Pseudoaneurysms are frequently identified for the first time during digital subtraction angiography. Recognizing their presence is essential for treatment planning. Acute pseudoaneurysms associated with true aneurysmal rupture can be safely and successfully treated by endovascular coiling of the true aneurysm. Care must be taken to avoid manipulation of the pseudoaneurysmal sac during the embolization.
Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA.
Vijay
V
Yanamadala
Department of Neurosurgery, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA.
Ning
N
Lin
Department of Neurosurgery, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA.
Hekmat
H
Zarzour
Department of Neurosurgery, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA.
Kai U
KU
Frerichs
Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA. Electronic address: walcott.brian@mgh.harvard.edu.
Brian P
BP
Walcott
Department of Neurosurgery, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA.
Ajith J
AJ
Thomas
Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA.
Ajit S
AS
Puri
D017541:Aneurysm, False / Q000150:complications / Q000473:pathology / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000150:complications / Q000473:pathology / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000473:pathology; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000473:pathology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Aneurysm; Endovascular coiling; Pseudoaneurysm; Subarachnoid hemorrhage