Abstract
A 39-year-old female patient was referred to a neurologist by her general practitioner for the work-up of headache. The performed MRI/MRA examination revealed two tandem aneurysms of the right middle cerebral artery (MCA): the first aneurysm arose from the first temporal branch of the MCA measuring 3 mm; the second aneurysm was located at the MCA bifurcation with a diameter of 6 mm. In accordance with the patient’s wishes endovascular treatment of both aneurysms was planned. During coiling of the smaller aneurysm, a coil loop ruptured the aneurysm wall and the extravasation did not resolve with temporary balloon occlusion of the M1/M2 segment. Therefore, the aneurysm and its parent artery were occluded with nBCA injection under balloon protection, which resulted in instantaneous hemostasis. The resulting right temporal lobe infarct remained asymptomatic. The second aneurysm was treated 3 weeks later by pCONus1_HPC assisted coil occlusion under ASA monotherapy. A follow-up DSA 3 months later confirmed the satisfactory occlusion of both aneurysms. The management of periprocedural aneurysm rupture and the intracranial use of coated stent derivatives with reduced thrombogenicity are the main topics of this chapter.
Similar content being viewed by others
References
Aguilar-Pérez M, Kurre W, Fischer S, Bäzner H, Henkes H. Coil occlusion of wide-neck bifurcation aneurysms assisted by a novel intra- to extra-aneurysmatic neck-bridging device (pCONus): initial experience. AJNR Am J Neuroradiol. 2014;35(5):965–71. https://doi.org/10.3174/ajnr.A3807.
Ahn JM, Oh JS, Yoon SM, Shim JH, Oh HJ, Bae HG. Procedure-related complications during endovascular treatment of intracranial saccular aneurysms. J Cerebrovasc Endovasc Neurosurg. 2017;19(3):162–70. https://doi.org/10.7461/jcen.2017.
Brisman JL, Niimi Y, Song JK, Berenstein A. Aneurysmal rupture during coiling: low incidence and good outcomes at a single large volume center. Neurosurgery. 2008;62(6 Suppl 3):1538–51. https://doi.org/10.1227/01.neu.0000333816.79777.e0.
Choi HH, Ha EJ, Lee JJ, Yoo DH, Cho WS, Kim JE, Cho YD, Han MH, Kang HS. Comparison of clinical outcomes of intracranial aneurysms: procedural rupture versus spontaneous rupture. AJNR Am J Neuroradiol. 2017;38(11):2126–30. https://doi.org/10.3174/ajnr.A5344.
Darkwah Oppong M, Gembruch O, Pierscianek D, Köhrmann M, Kleinschnitz C, Deuschl C, Mönninghoff C, Kaier K, Forsting M, Sure U, Jabbarli R. Post-treatment antiplatelet therapy reduces risk for delayed cerebral ischemia due to aneurysmal subarachnoid hemorrhage. Neurosurgery. 2018; https://doi.org/10.1093/neuros/nyy550.
Doerfler A, Wanke I, Egelhof T, Dietrich U, Asgari S, Stolke D, Forsting M. Aneurysmal rupture during embolization with Guglielmi detachable coils: causes, management, and outcome. AJNR Am J Neuroradiol. 2001;22(10):1825–32.
Frontera JA, Provencio JJ, Sehba FA, McIntyre TM, Nowacki AS, Gordon E, Weimer JM, Aledort L. The role of platelet activation and inflammation in early brain injury following subarachnoid hemorrhage. Neurocrit Care. 2017;26(1):48–57. https://doi.org/10.1007/s12028-016-0292-4.
Grodecki K, Huczek Z, Scisło P, Kowara M, Raposeiras-Roubín S, D'Ascenzo F, Abu-Assi E, Henriques JPS, Saucedo J, González-Juanatey JR, Wilton SB, Kikkert WJ, Nuñez-Gil I, Ariza-Sole A, Song XT, Alexopoulos D, Liebetrau C, Kawaji T, Moretti C, Nie SP, Fujii T, Correia L, Kawashiri MA, García-Acuña JM, Southern D, Alfonso E, Terol B, Garay A, Zhang D, Chen Y, Xanthopoulou I, Osman N, Möllmann H, Shiomi H, Giordana F, Scarano S, Gaita F, Wang X, Yan Y, Fan JY, Ikari Y, Nakahashi T, Sakata K, Yamagishi M, Kalpak O, Kedev S, Opolski G, Filipiak KJ. Gender-related differences in post-discharge bleeding among patients with acute coronary syndrome on dual antiplatelet therapy: a BleeMACS sub-study. Thromb Res. 2018;168:156–63. https://doi.org/10.1016/j.thromres.2018.06.022.
Kawabata S, Imamura H, Adachi H, Tani S, Tokunaga S, Funatsu T, Suzuki K, Sakai N. Risk factors for and outcomes of intraprocedural rupture during endovascular treatment of unruptured intracranial aneurysms. J Neurointerv Surg. 2018;10(4):362–6. https://doi.org/10.1136/neurintsurg-2017-013156.
Lenz-Habijan T, Bhogal P, Peters M, Bufe A, Martinez Moreno R, Bannewitz C, Monstadt H, Henkes H. Hydrophilic stent coating inhibits platelet adhesion on stent surfaces: initial results in vitro. Cardiovasc Intervent Radiol. 2018;41(11):1779–85. https://doi.org/10.1007/s00270-018-2036-7.
Pérez MA, Bhogal P, Moreno RM, Wendl C, Bäzner H, Ganslandt O, Henkes H. Use of the pCONus as an adjunct to coil embolization of acutely ruptured aneurysms. J Neurointerv Surg. 2017;9(1):39–44. https://doi.org/10.1136/neurintsurg-2016-012508.
Ramakrishnan P, Yoo AJ, Rabinov JD, Ogilvy CS, Hirsch JA, Nogueira RG. Intra-arterial eptifibatide in the management of thromboembolism during endovascular treatment of intracranial aneurysms: case series and a review of the literature. Interv Neurol. 2013;2(1):19–29. https://doi.org/10.1159/000354982.
Ramchand P, Nyirjesy S, Frangos S, Doerfler S, Nawalinski K, Quattrone F, Ju C, Patel H, Driscoll N, Maloney-Wilensky E, Stein SC, Levine JM, Kasner SE, Kumar MA. Thromboelastography parameter predicts outcome after subarachnoid hemorrhage: an exploratory analysis. World Neurosurg. 2016;96:215–21. https://doi.org/10.1016/j.wneu.2016.04.002.
Schuette AJ, Hui FK, Spiotta AM, Obuchowski NA, Gupta R, Moskowitz SI, Tong FC, Dion JE, Cawley CM. Endovascular therapy of very small aneurysms of the anterior communicating artery: five-fold increased incidence of rupture. Neurosurgery. 2011;68(3):731–7; discussion 737. https://doi.org/10.1227/NEU.0b013e3182077373.
Soppi V, Kokki H, Koivisto T, Lehtonen M, Helin-Tanninen M, Lehtola S, Rinne J. Early-phase pharmacokinetics of enteral and parenteral nimodipine in patients with acute subarachnoid haemorrhage – a pilot study. Eur J Clin Pharmacol. 2007;63(4):355–61. https://doi.org/10.1007/s00228-007-0267-7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this entry
Cite this entry
Pérez, M.A., Hellstern, V., AlMatter, M., Bäzner, H., Henkes, H. (2019). Middle Cerebral Artery Bifurcation Aneurysm: Incidental Tandem Aneurysms of the Middle Cerebral Artery; Periprocedural Rupture of a Temporal Artery Aneurysm During Coil Insertion; Sealing of the Rupture Site and Parent Vessel Occlusion with nBCA; Subsequent Coil Occlusion of an MCA Bifurcation Aneurysm Assisted by a pCONus1_HPC Device Under Mono-antiaggregation with ASA Only. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_100-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-70267-4_100-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-70267-4
Online ISBN: 978-3-319-70267-4
eBook Packages: Springer Reference MedicineReference Module Medicine