Acute phase endovascular intervention on a pseudoaneurysm formed due to rupture of an anterior communicating artery aneurysm

Ito, Hidemichi; Morishima, Hiroyuki; Onodera, Hidetaka; Wakui, Daisuke; Uchida, Masashi; Sase, Taigen; Oshio, Kotaro; Tanaka, Yuichiro

doi:10.1136/neurintsurg-2013-011006.rep

Cited by 5 publications

(8 citation statements)

References 4 publications

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“…5 additionally reported radiological characteristics such as delayed appearance, late opacification, changing shape, and retention of the CM after venous phase. They proposed calling the aneurysm with pseudoaneurysm a “ghost aneurysm.” Other reports described similar radiological findings, unequal filling or outpouching of the CM, and unclear neck 6–12 as shown in Table 1. These radiological features are identical to those of traumatic pseudoaneusyms.…”

Section: Discussionsupporting

confidence: 58%

“…Reports describing the usefulness of endovascular embolization have been published. 9,11,12 In these reports, only the true portion of the aneurysm was embolized with platinum coils in most cases. In one case reported by Ito et al., 12 both true and pseudoaneurysm were embolized on day 9.…”

Section: Discussionmentioning

confidence: 98%

“…2 Since then, several reports describing pseudoaneurysm formation after aneurysmal rupture have been published. 4–12 However, intracranial pseudoaneurysm formation due to a ruptured non-traumatic aneurysm is still rare, and remains to be clarified. 3–12 Furthermore, pseudoaneurysms are difficult to manage and associated with a high risk of rupture during treatment.…”

Section: Introductionmentioning

confidence: 99%

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Pseudoaneurysm formation due to rupture of intracranial aneurysms: Case series and literature review

et al. 2017

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Background Intracranial pseudoaneurysm formation due to a ruptured non-traumatic aneurysm is extremely rare. We describe the radiological findings and management of pseudoaneurysms due to ruptured cerebral aneurysms in our case series and previously reported cases. Patients and methods Four additional and 20 reported patients presenting with subarachnoid hemorrhage (SAH) are included. Radiological findings and clinical features of these patients were reviewed. Results In our series, three-dimensional computed tomographic angiography (3D-CTA) and/or angiography showed an irregular- or snowman-shaped cavity extending from the parent artery. The radiological examination additionally revealed delayed filling and retention of contrast medium. These findings were the same as previously reported cases. One patient underwent direct clipping of the true aneurysm. For the other three patients with aneurysms at the basilar and anterior communicating arteries, the true portion of the aneurysm was embolized with platinum coils. During the procedures, care was taken not to insert the coils into the distal pseudoaneurysm portion to prevent rupture. The review of 24 cases revealed that the location of the aneurysms was most frequent in the anterior communicating artery (41.7%), and 86.7% of patients were in a severe stage of SAH (>Grade 3 in WFNS or Hunt & Kosnik grading) implying abundant SAH. Conclusions Pseudoaneurysm formation in SAH after non-traumatic aneurysm rupture is rare. However, in cases with an irregular-shaped aneurysm cavity, pseudoaneurysm formation should be taken into consideration.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Pseudoaneurysm formation due to rupture of intracranial aneurysms: Case series and literature review

et al. 2017

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“…Lee A. Tan et al reported that a ruptured lenticulostriate artery aneurysm, of which fewer than 50 cases have been reported in the literature8), with the spot sign was clipped17). Other authors published a case report on endovascular treatment of a pseudoaneurysm that formed due to rupture of an anterior communicating artery aneurysm10). Because of their rarity, the natural history and optimal management of pseudoaneurysms are not well understood.…”

Section: Discussionmentioning

confidence: 99%

The Role of digital subtraction angiography in the ventricular spot sign on the computed tomography angiography

Cho

Kim

Lee

et al. 2019

J Cerebrovasc Endovasc Neurosurg

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ObjectiveThe spot sign on computed tomography angiography is little known about the relationship between the spot sign and the results of cerebral angiography We retrospectively analyzed the spot sign, digital subtraction angiography results, and other factors.Material and MethodsFrom December 2009 to May 2014, DSA was performed in 52 ICH patients with non-specific location or abnormalities on CTA findings. 26 of those patients, whose initial CTA showed the spot sign, were analyzed. Two groups, one with the spot sign in the ventricle (Group A) and others with the spot sign in another location (Group B) were statistically compared.ResultsThe mean age of the study subjects was 46.9 years (range, 15 to 80 years) and the percentage of males was 53.8%. Thirteen of 26 patients had ICH without intraventricular hemorrhage, and 6 patients had co-existing IVH. In 17 cases, the DSA results were negative. Seven patients were diagnosed with pseudoaneurysms, and two cases showed developmental venous anomalies. Group A consisted of the 8 patients (30.8%) who showed the spot sign in a ventricle. The number of pseudoaneurysms was statistically significantly higher in Group A than in Group B (71.4% versus 28.6%; OR, 13.3; 95% CI, 1.7-103.8 P = 0.014). All three patients who underwent endovascular treatment were members of Group A (P = 0.022), whereas most (92.3%) of those in Group B underwent surgical evacuation. (P = 0.030).ConclusionWhen CTA shows the spot sign in a ventricle, it is a clue that an existing underlying vascular lesion requires endovascular treatment.

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“…In this case, being aware of the possibility of rupture, we opted for the endovascular treatment because it is a suitable-sized aneurysm, and it was thought that there was a safe distance between the neck and the aneurysmal wall for microcatheterization without extensive manipulation of the aneurysmal wall. [ 4 ]…”

Section: Discussionmentioning

confidence: 99%

Mixed aneurysm: A new proposed nomenclature for a rare condition

Crusius¹,

Aguiar²,

Crusius³

2017

Surg Neurol Int

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Background:Mixed intracranial aneurysms are vascular lesions appearing in the ruptured saccular aneurysms whose blood is contained by perivascular tissues forming another cavity called pseudoaneurysm. All cases until now have been reported in the literature with subarachnoid hemorrhage.Case Description:A 65-year-old woman presented with multiple brain aneurysms with no history of subarachnoid hemorrhage. Endovascular treatment was chosen for left-sided aneurysms [lateral carotid wall (LCW) and posterior communicating (PCom)]. After the embolization of the LCW aneurysm, the patient developed a left third nerve palsy. A head computed tomography scan was immediately performed which did not show any SAH. The control angiography demonstrated PCom aneurysm with intraaneurysmal contrast retention even in the venous phase, along with modification of the aneurismal sac format, leading to diagnoses of mixed aneurysm. The PCom aneurysm was successfully coiled and an operation was performed to clip the right side aneurysms. The patient was discharged after 10 postoperative days.Conclusion:Mixed intracranial aneurysm has special radiological characteristics that should be promptly recognized to offer the best treatment.

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Acute phase endovascular intervention on a pseudoaneurysm formed due to rupture of an anterior communicating artery aneurysm

Cited by 5 publications

References 4 publications

Pseudoaneurysm formation due to rupture of intracranial aneurysms: Case series and literature review

Pseudoaneurysm formation due to rupture of intracranial aneurysms: Case series and literature review

The Role of digital subtraction angiography in the ventricular spot sign on the computed tomography angiography

Mixed aneurysm: A new proposed nomenclature for a rare condition

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