Endovascular Interventions in Ruptured Intracranial Aneurysms and Arteriovenous Malformations - Initial Experience

Abstract

Introduction: Endovascular treatment of ruptured aneurysms and arterio-venous malformations (AVMs) is often challenging because of there locations and structure. Emergency action in first hours to days after haemorrage is crucial for saving the patient's life. Aim: To present the first emergency steps and strategy in diagnosis and treatment of intracranial vascular malformations and aneurysms after acute bleeding. Material and Methods: For period of one year seventeen patients with acute subarachnoid hemorrhage underwent CT, CT angiography with multiplanar and 3D reconstructions, MRI and DSA. Fourteen patients presented with ruptured aneurysms and 3 with AVMs. All the AVMs were classified according to Spetzler-Martin scale as Grade III or higher. Results: All patients underwent endovascular treatment. In two patients with aneurysms, the embolization was unsuccessful due to some anatomical peculiarities. In the patient's group with AVMs was used the embolic agent ONYX, as one patient underwent repeated embolization. In the group with ruptured aneurysms were used 3D and helical mechanically detachable coils. Endovascular complications were associated with permanent neurological defficite in 2 patients (11.7%) and one death (5.9%) on the third day after the intervention. Conclusion: Endovascular treatment in patients with acute intracranial hemorrhage after rupturing of brain aneurysms or AVMs is fast end safe. This is the method of choice in patients in poor clinical condition and represents an attractive alternative of open surgery.