Intracranial hematoma after stent treatment disappearance of ruptured anterior cerebral artery aneurysms with internal carotid artery stenosis

Shui Yu; Chengjian Sun; Yanhua Wang; Chunpeng Yu

doi:10.4103/bbrj.bbrj_79_17

CASE REPORT

Year : 2017 | Volume : 1 | Issue : 2 | Page : 163-165

Intracranial hematoma after stent treatment disappearance of ruptured anterior cerebral artery aneurysms with internal carotid artery stenosis

Shui Yu, Chengjian Sun, Yanhua Wang, Chunpeng Yu
Department of Interventional Medical Center, The Affiliated Hospital of Qingdao University Medical College, Qingdao, Shandong, China

Date of Web Publication

23-Nov-2017

Correspondence Address:
Chengjian Sun
Department of Interventional Medical Center, The Affiliated Hospital of Qingdao University Medical College, Jiangsu Road 16, Qingdao 266003, Shandong
China

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bbrj.bbrj_79_17

Abstract

A male patient presented with explosive headache and urinary incontinence due to intracranial hemorrhage, a small aneurysm of the right anterior cerebral artery and severe stenosis of the left internal carotid artery was diagnosis via digital subtraction angiography (DSA). Interestingly, DSA revealed aneurysms disappeared. Stent was performed in the left internal carotid artery. Moreover, vascular angioplasty was performed at the location of the aneurysm to reduce the risk of aneurysm rupture. Unfortunately, the patient suffered from intracranial hemorrhage and discharged with hemiparesis.

Keywords: Intracranial hemorrhage, ruptured intracranial aneurysms, vascular angioplasty, vascular stenosis

How to cite this article:
Yu S, Sun C, Wang Y, Yu C. Intracranial hematoma after stent treatment disappearance of ruptured anterior cerebral artery aneurysms with internal carotid artery stenosis. Biomed Biotechnol Res J 2017;1:163-5

How to cite this URL:
Yu S, Sun C, Wang Y, Yu C. Intracranial hematoma after stent treatment disappearance of ruptured anterior cerebral artery aneurysms with internal carotid artery stenosis. Biomed Biotechnol Res J [serial online] 2017 [cited 2023 Jun 5];1:163-5. Available from: https://www.bmbtrj.org/text.asp?2017/1/2/163/219111

Introduction

Intracranial hemorrhage has a high mortality and morbidity, intracranial aneurysms is the most common cause.^[1] There are very few reports of intracranial aneurysm complicated with severe stenosis of blood vessel. Moreover, the disappearance of ruptured intracranial aneurysms is very rare. There is no consensus management of the disappearance of ruptured aneurysms. More studies are necessary to provide a guideline for future clinical treatment.

Case Report

A 59-year-old man complained of an acute onset severe headache for 2 weeks. Additional complaints included hypopsychosis, less fluent in speech, and urinary incontinence. He has prior histories of hypertension. NIHSS Score: 2. Magnetic resonance imaging (MRI) revealed intracranial hemorrhage in right frontal lobe and anterior part of the corpus callosum [Figure 1]. A small aneurysm in right anterior cerebral artery [Figure 2]a and b] and severe stenosis of left internal carotid artery was diagnosis through digital subtraction angiography (DSA) after 17 days [Figure 2]c and d].

Figure 1: (a and b) Magnetic resonance imaging demonstrated intracranial hemorrhage

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Figure 2: (a) Digital subtraction angiography revealed a small aneurysm (3.7 mm × 2.8 mm) (arrow) in the right anterior cerebral artery. (b) The location and shape of the aneurysm (arrow) can be seen on three dimensional reconstructions. (c and d) Angiography revealed severe stenosis (>90%) at the beginning of the left internal carotid artery

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Heparin boluses (70 IU/kg) were administered. Distal protection device was introduced into internal carotid artery. The stenotic lesion was predilated with a diameter balloon catheter [Figure 3]a. A self-expanding carotid stent was deployed across the stenosis [Figure 3]b. Angiogram demonstrates intracranial perfusion significantly increased after removing the protection device [Figure 3]c.

Figure 3: (a) A 3 mm × 20 mm balloon was performed to predilated stenotic lesion. (b) A (7–10) mm × 40 mm self-expanding stent was placed in the stenotic lesion. (c) Angiography reveals anterograde blood perfusion was significantly increased. (d) Aneurysm (arrow) complete disappeared in the next angiogram. (e) The location and shape of the aneurysm were showed on the previous three dimensional angiography (arrow). (f) 2.5 mm × 17 mm LVIS stent was located in the position of aneurysm

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Under general anesthesia, DSA showed complete resolution of the aneurysm [Figure 3]d. Since carotid stenting has been performed, postoperative double platelet therapy is necessary. To reduce the risk of aneurysm rupture, a LVIS stent was introduced into the location of aneurysm [Figure 3]f where was detected in previous three dimensional angiography [Figure 3]e.

Postoperative blood pressure was not effectively controlled, nausea and vomiting symptom occurred on the 1^st day after the operation. Subsequently, the patient had a rapid decline in his neurologic functioning accompanied by impaired consciousness and positive meningeal irritation sign, NIHSS Score: 19. Computed tomography scan showed intracranial hemorrhage and intraventricular hemorrhage with brain edema. External ventricular drainage surgery was preformed. Fortunately, the patient gradually stabilized and discharged with hemiparesis and unclear speech, NIHSS Score: 5.

Discussion

How to deal with the anterior in the case of severe stenosis is contradictory. Nevertheless, considering the spontaneous healing of ruptured anterior, conservative management, or aggressive treatment still on debate.^[2],[3] Although the complete disappearance of the ruptured aneurysm is a favorable, the aneurysm could be recanalized and subsequent rerupture.^[4] Due to MRI reveal the anterior have ruptured repeatedly, spontaneous healing of ruptured anterior does not guarantee protection against further bleeding. Therefore, aggressive treatment should be conducted. The implanted stent not only redistribution of flow away from the aneurysm, but also induce aneurysmal thrombosis and occlusion phenomenon.^[5]

However, we must be aware of the potential risks of stent implantation, such as stent thrombosis, intracranial bleeding, and stent stenosis.^[6] Besides, the antiplatelet aggregation was given to prevent stent thrombosis will delay the formation of aneurysms thrombus. Hence, it is essential to careful control of the dosage of antiplatelets.

Conclusion

In the case of aneurysm rupture risk, surgical or endovascular should be administered. More studies are needed to explore the mechanism of spontaneously healing of aneurysms to be applied to clinical.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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