Abstract
Objective – to improve treatment results of patients with ruptured brain aneurysms using follow-up cerebral digital subtraction angiography to avoid de novo or aneurismal regrow.Materials and methods. Analysis of follow-up cerebral digital subtraction angiography and treatment results of two patient (60 and 64-year-old females) with brain anterior communicated artery de novo aneurysm and regrowed aneurysm of an anterior communicated artery after microsurgical clipping.Results. Two patient underwent endovascular treatment of ruptured brain aneurysms after non follow-up cerebral digital subtraction angiography. In first case de novo aneurysm of anterior communicating artery and in second – regrowed aneurys of anterior communicating artery after surgical clipping. Both patients were discharged from the clinic in I and IV modified Rankin scale. Conclusions. Digital subtraction angiography follow-up of intracranial aneurysms treated by endovascular or microsurgical approach is important for the detection and prediction for the risk of bleeding (aneurysm recurrence and de novo aneurysm). There exist no guidelines on the frequency of monitoring and imaging modality to adopt and the monitoring is adapted on a case-by-case basis. Digital subtraction angiography is the gold standard for the evaluation of aneurysmal occlusion after coiling and microsurgical clipping and remains also necessary for evaluating other devices.
Highlights
OF RUPTURED INTRACRANIAL ANEURYSMS TO EXCLUDE DE NOVO OR ANEURYSMAL REGROW AND AVOID ITS RUPTURE: REPORT OF 2 CASES
Digital subtraction angiography follow-up of intracranial aneurysms treated by endovascular or microsurgical approach is important for the detection and prediction for the risk of bleeding
There exist no guidelines on the frequency of monitoring and imaging modality to adopt and the monitoring is adapted on a case-by-case basis
Summary
Two patient underwent endovascular treatment of ruptured brain aneurysms after non follow-up cerebral DSA. A CT-scan showed acute subarachnoid hemorage (SAH) with intraventricular clot – Fisher scale IV (Fig. 3) and patient was moved into cath lab for DSA which identified occlusion of the left ICA aneurysm and de novo AcomA aneurysm with diverticulitis on its fundus. A CT-scan and DSA showed: acute SAH with intraventricular clot – Fisher scale IV and multiple (2) aneurysms of AcomA (proximal – 2.0 mm and distal – 1.8 mm) (Fig. 6 and 7). DSA we found that proximal aneurysm of AcomA was successfully clipped but distal aneurysm was partially clipped and has grown up in size (3.5 mm) (Fig. 9). Intraoperative control DSA showed that active AcomA aneurysm was doppelt in size (6 mm) and instant coiling was performed (Fig. 10 and 11).
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