Journal of neurointerventional surgery
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Stent assisted coiling of unruptured wide necked intracranial aneurysms require antiplatelets to prevent stent thrombosis. The effect of the loading dose of antiplatelets prior to the stent coiling procedure in an unsecured wide necked ruptured intracranial aneurysm is not known. ⋯ In our series of carefully selected patients, therapeutic dual antiplatelet loading prior to stent assisted coiling of ruptured wide necked intracranial aneurysm was not associated with increased bleeding complications. However, thromboembolic events remain the main challenge. Further study is required to confirm the safety of antiplatelet loading in stent assisted ruptured intracranial aneurysm coiling.
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The outcome of failed recanalization in patients with acutely symptomatic intracranial vertebrobasilar (VB) artery occlusive disease is poor. This paper reports the recanalization rate and safety of VB artery stenting in acutely symptomatic patients presenting >8 h after onset of symptoms. ⋯ Stent-supported VB artery revascularization can be a viable option with an acceptable safety profile in acute VB occlusion or unstable intracranial atherosclerotic arterial disease (ICAD) in carefully selected patients.
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Case Reports
Endovascular management of symptomatic vertebral artery origin stenosis in the presence of an acute thrombus.
A woman in her early 60s with hypertension and hyperlipidemia was undergoing investigations for anemia of unknown etiology. She developed a sudden reduction in visual acuity and bilateral visual field impairment. MRI and angiography revealed acute infarcts in the posterior circulation and severe narrowing of the left vertebral artery origin. ⋯ She was discharged to a rehabilitation facility 4 days later without worsening or new neurological deficits. A search of the literature yielded a similar report managed with anticoagulation and subsequent VOAS after complete lysis of the thrombus. Our report highlights the technique, safety and feasibility of VOAS in the presence of a thrombus using a flow reversal technique and distal protection.
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Integration of data from clinical trials and advancements in technology predict a change in selection for treatment of patients with cerebral aneurysm. ⋯ The majority of unruptured aneurysms in the USA are now treated with endovascular coiling. Although surgical clipping is used for treatment of most ruptured aneurysms, its use is decreasing over time. Dissemination of endovascular procedures appears widespread across patient and hospital subgroups.