/
Emergency Treatment of a Ruptured Anterior Communicating Artery Aneurysm via Balloon Assisted Emergency Treatment of a Ruptured Anterior Communicating Artery Aneurysm via Balloon Assisted

Emergency Treatment of a Ruptured Anterior Communicating Artery Aneurysm via Balloon Assisted - PowerPoint Presentation

brown
brown . @brown
Follow
343 views
Uploaded On 2022-02-14

Emergency Treatment of a Ruptured Anterior Communicating Artery Aneurysm via Balloon Assisted - PPT Presentation

Clinical presentation 69 yo female with a 3 day history of posterior cervical pain and posterior headache On 81315 at 230 PM she presented with sudden severe worsening of her pain reported as 1010 with some photophobia and dizziness ID: 908823

anterior aneurysm communicating head aneurysm anterior head communicating artery treatment arrow yellow admission image growth plan significant patient neck

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "Emergency Treatment of a Ruptured Anteri..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

Emergency Treatment of a Ruptured Anterior Communicating Artery Aneurysm via Balloon Assisted Coiling

Slide2

Clinical presentation

69 y/o female with a 3 day history of posterior cervical pain and posterior headache.

On 8/13/15 at 2:30 PM she presented with sudden severe worsening of her pain, reported as 10/10 with some photophobia and dizziness

EMS contacted

Patient brought to the

Umass

ED

She was alert,

somnolient

but

arousable

with no gross motor or sensitive deficit

Slide3

CT of the head from 3 years prior to current admission

Axial CT image of the head demonstrated a bulbous appearance of the anterior communicating artery

Coronal CT reconstructed image of the neck which partially included the head demonstrated again the bulbous appearance of the anterior communicating artery. This was consistent with a small blister-like aneurysm.

Slide4

Admission

Noncontrast

CT of the head

Axial CT image of the head demonstrating diffuse subarachnoid hemorrhage in the basal and

Sylvian

cisterns (yellow arrows). Also, mild hydrocephalus (yellow arrowheads)

Coronal CT reconstructed image of the head demonstrating

the SAH

Slide5

Admission CTA of the head

A 4 mm anterior communicating artery aneurysm pointing superiorly,

anteriorly

and right laterally, likely the source of the intracranial bleed (yellow arrows). When compared to the prior CT of the head from 3 years ago, there has been significant interval growth of this aneurysm

Slide6

Diagnosis

Acute rupture of an anterior communicating artery aneurysm with secondary subarachnoid hemorrhage, Hunt & Hess 2

Plan for treatment:

Neurosurgery to place an

extraventricular

drainage catheter for treatment of hydrocephalus and intracranial pressure monitoring.NeuroInterventional Radiology consulted. Plan is to characterize the aneurysm and outline treatment accordingly

Slide7

Digital subtraction angiographic magnified oblique view of the anterior communicating artery aneurysm (white arrow).

Slide8

3-Dimensional C-arm rotational

Angiogram performed on the

NeuroInterventional

Suite further characterizes the ruptured aneurysm (red arrow) and the vascular anatomy to plan treatment.

Note the low dome to neck ratio and wide neck. An adjunctive device, likely a balloon, will be required when coiling.

Slide9

Frontal oblique view shows the inflated balloon (red arrow) which assists in the placement of platinum coils (yellow arrow) into the aneurysm pouch.

Slide10

Final angiogram demonstrates lack of filling of the aneurysm Three small platinum coils (white arrow) have occluded the

aneurysmal

pouch. Patency of both the right and left anterior cerebral arteries is preserved.

Slide11

Outcomes

On post treatment day # 1 the patient reports significant improvement of her headache.

She has no neurological deficits

She will continue her recovery in the

NeuroICU

during the next several days.

Slide12

Ongoing research at UMass

As shown in this case, this patient had significant interval growth of her anterior communicating artery aneurysm from 2012 until her current admission.

At the New England Center for Stroke Research (http://www.umassmed.edu/necstr/), Dr. Matthew Gounis and his team are conducting NIH funded investigations into the causes for aneurysm growth and aneurysm rupture.

Dr. Gounis and his team are also working on advanced imaging techniques which would help further characterize this aneurysm inflammation and growth.