Background 43 years old married lady was admitted with sudden onset severe headache.She underwent 3 D DSA which showed a bilobed 3mm x 3mm narrow necked AnteriorCommunicating artery aneurysm, which is pointing inferiorly! This is appreciable in superior ,inferior and lateral views.Immediately after the DSA , the patient underwent endovascular coiling and total obliteration was achieved without any vascular compromise.The time taken was 40 minutes.The patient was transferred to the referring hospital after 24 hours
1. Diagnostic DSA and endovascular coiling can be done as a single procedure ,
2. Hyperacute management of SAH involves an immediate DSA followed by endovascular coiling.
3. The recovery time can considerably reduced .
4. Inferiorly pointing ACOM aneurysms are easy to treat by endovascular route since the direction helps in easy entry of microcatheter into the aneurysm.
5. Excluding the aneurysm from the circulation helps in effective management of vaso spasm by HHH therapy
Aneurysmal SAH patients needs to be evaluated and treated with the same urgency as acute ischemic stroke patients.Please share your comments , opinions and thoughts