Aneurysmal and Perianeurysmal Changes After Endovascular Treatment: from Inflammation to Microbleed. A Case Report

Abstract

Nevertheless thrombosis followed by organization and neo-intimal closure of the neck is required for successful occlusion of treated aneurysms, thus there must be further elements to consider for thrombosis leading to rupture rather than occlusion.This report describes the favourable outcome of a focal wall rupture affecting a large carotid-ophthalmic artery aneurysm treated with FD and coils deployment. It displays the potential interaction between thrombosis, inflammation and residual flow in the aneurysm. Case ReportA 64-year-old woman was admitted to the neurosurgical department due to rapid progressive loss of visual acuity in her left eye. Computed tomography (CT) and magnetic resonance (MR) scans disclosed a giant aneurysm (20 × 24 × 27 mm) in the right carotid siphon. Ophthalmic examination showed right temporal hemianopia with 2/50 vision in the left eye and 1-2/10 in the right.A manual right carotid artery compression test performed at the neck during angiography showed insufficient crossover flow (4-seconds delay in the appearance of the internal cerebral veins). Therefore we opted to treat the aneurysm with a new generation of softer platinum coils with a larger diameter than conventional embolic coils (Penumbra coils 400) and deployment of FD stent (Silk BALT 4 × 30 mm) across the aneurysm neck.The treatment was performed under general anaesthesia after 7 days of dual antiplatelet therapy (clopidogrel 75 mg × 1 e ASA 100 mg × 1) and sensitivity to treatment was tested by the VerifyNow ® . The procedure lasted around 180 min and resulted in subtotal occlusion of the aneurysm sac and good positioning of Silk stent.

Vessel-wall MRI in thunderclap headache: A useful tool to answer the riddle?

“…Such wall instability is determined by the presence of structural changes, as well as neovascularization, remodelling, degeneration, and destabilization of wall layers due to the local invasion of macrophages and other inflammatory cells. 7,8,22,23 The abundance of inflammatory cells has been demonstrated associated with a higher density of vasa vasorum, 9 which typically could be detected in IA larger than 4 mm or in the case of mural inflammation and wall remodelling. 11…”