Abstract
An acute subdural hematoma (SDH) without subarachnoid hemorrhage (SAH) is an unusual presentation of a ruptured intradural aneurysm. A 30-year-old male patient presented with an acute left hemispheric SDH after the rupture of a pseudoaneurysm in the context of an intracranial internal carotid artery (ICA) dissection, located at the superior aspect of the supraclinoid ICA segment. This episode caused a typical headache attack with nausea and transient loss of consciousness, apparently related to moderate physical exercise. The dissected arterial segment was treated with a single flow diverter (“Flow Redirection Endoluminal Device,” FRED; MicroVention). The wall apposition of this implant was incomplete due to a twist in the ophthalmic curve of the ICA. This technical issue caused symptomatic embolic events days after the treatment, and an angioplasty of the ovalized stent was required. Although the final wall apposition of the flow diverter (FD) remained suboptimal, the patient improved clinically, without any neurological deficit. During the first months of the follow-up, the stented segment developed both a progressive in-stent stenosis and an endoleak in the anterior part of the ophthalmic ICA, which supplied the ophthalmic artery. Consequently, the dual antiplatelet medication was maintained for 1 year. The stenosis improved spontaneously after 12 months. However, the endoleak persisted, compartmentalizing of the ophthalmic ICA, without any hemodynamic repercussion on the ophthalmic arterial flow. The patient remained neurologically intact in the long term, and the aneurysm was occluded more than a year after the treatment. Issues in endovascular treatment of intradural dissecting aneurysms using FRED are the main topic of this chapter.
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Martinez Moreno, R., García Bautista, E., Tomás Muñoz, P., Alcázar Romero, P.P. (2018). Supraclinoid Internal Carotid Artery Aneurysm: Ruptured Dissecting ICA Pseudoaneurysm, Endovascular Treatment using a FRED, Twisting with Thrombus Formation, Early Aneurysm Occlusion, Balloon Angioplasty and Telescoping Stenting, Transient In-Stent Stenosis. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_50-1
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DOI: https://doi.org/10.1007/978-3-319-70267-4_50-1
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