Rescue Stenting in Endovascular Treatment of Acutely Ruptured Cerebral Aneurysms

Abstract

<jats:p> Thromboembolic events and major artery occlusion following cerebral aneurysm coiling may lead to serious complications and even death if not treated. The use of an intracranial stent in the setting of subarachnoid hemorrhage (SAH) is risky due to the need for antiplatelet therapy. However in some conditions it could be an effective solution for this major problem. This study describes a revascularization technique using a Solitaire stent for treatment of anterior cerebral artery (ACA) occlusion following coiling of anterior communicating artery (Acom) aneurysms. Three cases of ruptured Acom aneurysms treated during the course of SAH underwent unplanned deployment of an intracranial stent. Complete occlusion of the ACA at the origin of the A2 segment developed during or shortly after coiling. Emergent CT brain scan was done in two cases to exclude rebleeding. Follow-up CT or MRI scans were performed 24 hours after stenting. Technical success was achieved in all cases. Complete revascularization of the Acom was achieved post stent deployment (TIMI grade 3). Time from onset of symptoms to full revascularization in the three cases was 35 minutes, one hour 50 minutes and two hours 40 minutes respectively. No intracranial bleeding occurred in any case following the procedure. No neurological changes occurred in case 1; mild neurological and radiological changes occurred in cases 2 and 3. Deployment of an intracranial stent achieved complete revascularization of the occluded Acom. Its use in a context of SAH is relatively risky but the technique resulted in a significant improvement of symptoms following flow restoration and probably helped prevent symptoms worsening, major disability or even death. A study on a larger patient sample with long-term follow-up will be of value. </jats:p>

Parent artery stenting as a rescue management for stretched coils during cerebral aneurysms embolization: Report of three cases and review of literature

“…Above all, additive propagating parent artery thrombosis that no distal flow could be seen past supraclinoid segment in the second case drove us to deploy a self-expandable Solitaire® stent; proved to be efficacious in the setting of acute intravascular thrombosis, aiming to stabilize the coil against vessel wall altogether with blood flow restoration after vessel reopening via stent deployment following on-site loading with ASA and clopidogrel. As Mahmoud 30 stated, although deemed to be risky in case of ruptured aneurysms, however, it proved to be safe with no short-term complications and effectively prevent neurological compromise and associated lasting disabilities. Only two stents were available in our stock (Solitaire-AB [Ev3, Irvine, USA] and Leo [Balt, Montmorency, France]).…”