Abstract Details

Title Exceptional case of rapid growth and ruptured of a very small asymptomatic unruptured intracranial aneurysm which was stable over years in a 72 years old active smoker

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P13 - Poster Session 13 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-015

Objective We report a 2mm asymptomatic unruptured intracranial aneurysm (AUIA) without growth over 4 years which ruptured within 9 months of the last imaging. Additionally, we like to report the endovascular strategies to repair the aneurysm.

Background

Accurate prediction of AUIA growth is difficult, and the management of AUIA is controversial, especially those are small and demonstrate no growth, and later present as subarachnoid hemorrhage (SAH).

Design/Methods Chart review

Results 72-year-old Caucasian woman with history of hypertension and active smoking was evaluated in 2015 for recurrent transient ischemic attacks. Cerebral angiography identified multiple small AUIA; 2mm aneurysms in the left posterior communicating arteries and right ophthalmic artery. Considering patient’s age, being asymptomatic, and no family history for aneurysms, the decision was made to monitor rather than to treat. She was followed with annual MRA through 2018 at which the aneurysms were stable at 2mm without symptoms. 9 months later, she presented with SAH with a Hunt and Hess grade IV and Fisher scale 4. She was intubated, ventilated and a ventricular drain was placed resulting improved grade to IIIb. Planning angiogram demonstrated aneurysm growth of12mm and had three lobes. Patient underwent planned endovascular repair of the aneurysm next morning for primary coiling and possible rescue stenting: a microcatheter was placed in the middle cerebral artery for possible stenting and a second microcatheter was placed in the distal lobes of the aneurysm. The aneurysm was secured with coiling. However, the proximal loop of the last coil prolapsed to the parent artery which was jailed with an Atlas stent after nasogastric delivery of crushed aspirin and clopidogrel load with one-hour absorption time. Patient grade improved to II.

Conclusions

Patients with multiple small intracranial aneurysms with history of active smoking may require more frequent evaluation. Additionally, if smoking cessation is not possible, proactive endovascular repair may be indicated.

Authors/Disclosures
Yahia M. Lodi, MD, F�鶹��ýӳ�� (Downstate Health Sciences University/OBH-Brookdale University Hospital) PRESENTER	Dr. Lodi has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file

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