Abstract
A 58-year-old female patient was diagnosed with an incidental aneurysm of the left vertebral artery (VA) adjacent to the origin of the posterior inferior cerebellar artery (PICA). The wide-necked saccular aneurysm was partially thrombosed and exerted a minor space occupying effect on the brain stem. Stent-assisted coil occlusion was followed by a major recurrent perfusion of the aneurysm 6 months later. After a further 19 months, the reperfusion of the aneurysm had further increased. When the intended p64 flow diverter (FD) was implanted, the aneurysm was found to be almost entirely thrombosed. This was most likely related to the intake of metamizole, which undermines the ability of acetylsalicylic acid (ASA) to inhibit platelet function. Just 3 months after implanting the p64 flow diverter (FD), another significant reperfusion of the aneurysm was observed. In the meantime, the patient had continued occasional taking metamizole, but now mostly separate from ASA. In addition, a significant perianeurysmal inflammatory reaction and contrast enhancement of the aneurysm wall was observed. Almost 5 months after implanting the p64, a PED Flex FD was telescopically deployed into the left V4 segment. This second FD, alongside anti-inflammatory medication, led to the aneurysm being excluded from blood circulation. The thrombus-induced inflammation of the aneurysm wall and the adjacent brain stem ceased. The interaction of ASA and metamizole in the context of treating aneurysms by flow diversion is the main topic of this chapter.
This is a preview of subscription content, log in via an institution.
References
Fischer S, Vajda Z, Aguilar Perez M, Schmid E, Hopf N, Bäzner H, Henkes H. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology. 2012;54(4):369–82. https://doi.org/10.1007/s00234-011-0948-x.
Fischer S, Aguilar-Pérez M, Henkes E, Kurre W, Ganslandt O, Bäzner H, Henkes H. Initial experience with p64: a novel mechanically detachable flow diverter for the treatment of intracranial saccular sidewall aneurysms. AJNR Am J Neuroradiol. 2015;36(11):2082–9. https://doi.org/10.3174/ajnr.A4420.
Polzin A, Zeus T, Schrör K, Kelm M, Hohlfeld T. Dipyrone (metamizole) can nullify the antiplatelet effect of aspirin in patients with coronary artery disease. J Am Coll Cardiol. 2013;62(18):1725–6. https://doi.org/10.1016/j.jacc.2013.07.039.
Polzin A, Richter S, Schrör K, Rassaf T, Merx MW, Kelm M, Hohlfeld T, Zeus T. Prevention of dipyrone (metamizole) induced inhibition of aspirin antiplatelet effects. Thromb Haemost. 2015;114(1):87–95. https://doi.org/10.1160/TH14-11-0922.
Schmitz A, Romann L, Kienbaum P, Pavlaković G, Werdehausen R, Hohlfeld T. Dipyrone (metamizole) markedly interferes with platelet inhibition by aspirin in patients with acute and chronic pain: a case-control study. Eur J Anaesthesiol. 2017;34(5):288–96. https://doi.org/10.1097/EJA.0000000000000581.
Sedat J, Chau Y, Gaudart J, Sachet M, Beuil S, Lonjon M. Stent-assisted coiling of intracranial aneurysms using LEO stents: long-term follow-up in 153 patients. Neuroradiology. 2018;60(2):211–9. https://doi.org/10.1007/s00234-017-1965-1.
Voigt P, Schob S, Jantschke R, Nestler U, Krause M, Weise D, Lobsien D, Hoffmann KT, Quäschling U. Stent-assisted coiling of ruptured and incidental aneurysms of the intracranial circulation using moderately flow-redirecting, braided Leo stents – initial experience in 39 patients. Front Neurol. 2017;8:602. https://doi.org/10.3389/fneur.2017.00602.
Xu J, Wu Z, Yu Y, Lv N, Wang S, Karmonik C, Liu JM, Huang Q. Combined effects of flow diverting strategies and parent artery curvature on aneurysmal hemodynamics: a CFD study. PLoS One. 2015;10(9):e0138648. https://doi.org/10.1371/journal.pone.0138648.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this entry
Cite this entry
Richter, C., Hoffmann, KT., Köhlert, K., Quäschling, U., Schob, S. (2018). Vertebral Artery Aneurysm: Stent-Assisted Coil Occlusion, Early Reperfusion, ASA/Metamizol Interaction with Poorly Controlled Platelet Function Inhibition, p64 Implantation, Aneurysm Reperfusion and Thrombus-Related Inflammation, Telescoping PED Implantation and Anti-Inflammatory Medication; Angiographic Exclusion of the Aneurysm, Regression of the Inflammation and Good Clinical Outcome. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_52-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-70267-4_52-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-70267-4
Online ISBN: 978-3-319-70267-4
eBook Packages: Springer Reference MedicineReference Module Medicine