An unruptured posterior communicating artery aneurysm ruptured during angiography

Abstract

Introduction Cerebrovascular imaging is the gold standard for diagnosis of intracranial aneurysms. Rupture of intracranial aneurysm is rare in cerebrovascular angiography, especially in unruptured intracranial aneurysm. Patient concerns A 74-year-old woman was admitted to the hospital for sudden onset of left eyelid ptosis for 1 day with no obvious inducement. The patient had a history of hypertension. Physical examination revealed that she had clear consciousness and normal speech, but the left eyelid drooped. The left pupil diameter was 5 mm and light reflex was absent. The left eyeball could not move, and the right eye examinations were normal. The limb muscle strength and muscle tension were normal. Diagnosis Bilateral internal carotid artery posterior communicating aneurysm, severe stenosis of the origin of left carotid artery, and right oculomotor nerve palsy. Interventions After the hospital, the aneurysm ruptured and hemorrhaged during radiography, and the patient improved after immediate rescue and treatment. On the third day after angiography, the patient's the condition gradually stabilized. Under the general anesthesia, left carotid artery stenosis stent implantation and left posterior communicating artery aneurysm stent assisted coil embolization were performed successfully. On the second day after embolization, the patient's head computed tomography (CT) showed subarachnoid hemorrhage with hydrocephalus. The patient underwent external ventricular drainage. A month later, the patient underwent ventriculoperitoneal shunt. Outcomes Six months later, the patient visited our hospital for a follow-up, and she was clear-headed, aphasia, right limb hemiplegia with muscle strength grade II, left side autonomous activities, and the GOS score was 2 points. Head CT showed the ventricles were normal. Conclusions Acute oculomotor palsy may be a risk factor for rupture of ipsilateral unruptured aneurysms, but more basic research and clinical trial evidence of intracranial aneurysms are needed to confirm this.

Traumatic Aneurysm Involving the Posterior Communicating Artery

“…For example, a small neck that reduces blood flow within the aneurysm could be an indicator of endothelial dysfunction [30,32]. However, the most important factor to assess a pre-existing aneurysm remains size [32,33]. Conversely, in TICAs, it should be assessed if central or peripheral vessel rupture corresponds to nearby rigid structures [34,35].…”

Single-Stage Endovascular Treatment of Severe Cranial Artery Stenosis Coexisted With Ipsilateral Distal Tandem Intracranial Aneurysm

“…By reviewing the literature, we observed the fact that symptomatic presentation was more often caused by severe cranial artery stenosis in the majority of the patients, and coexisted ipsilateral distal tandem intracranial aneurysms were usually detected occasionally. But coexisted ipsilateral tandem intracranial aneurysm could still cause symptoms or even rupture ( 1 , 4 ), although it was in the territory of the severe stenotic proximal cranial artery with theoretically decreased cerebral blood flow. Such tandem intracranial aneurysms are mostly located at the range of the circle of Willis.…”

“…Although various treatment options have been proposed, there is still no consensus on treatment for such a kind of concomitant lesions. Until now, only a few studies and case reports have reported successful treatment of both tandem lesions in anterior circulation by a single-stage endovascular procedure ( 1 – 4 ). In addition, the effective treatment for such tandem lesions in posterior circulation is even rarely reported in the literature.…”