Ctrl + Alt+ Delete ANEURYSM

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

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Highlights

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

 

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3 thoughts on “Ctrl + Alt+ Delete ANEURYSM

  1. Hi Gigy,
    Last week I clipped a similar inferiorly pointing Acom aneurysm with a wide neck. Interventionist was in 2 minds about coiling it for the fear straightening the vessel during catheterisation with a risk of rupture. Even though such a risk exists during lifiting frontal lobe during surgery as well, I didn’t find the dome adherent to dura in this case

    • Thanks ramesh
      Now 90 degree preshaped microcatheters are available which
      reduces vessel straightening.
      In this case acom could be sacrified
      Since the aca on each side were indepedant. So i didnt use a balloon also
      Thanks
      Gigy

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