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Petrous Internal Carotid Artery Aneurysm: Giant Fusiform Aneurysm, Flow Diversion, Several Treatment Sessions, Metamizole Intake Five Years After the Initial Treatment, Thrombotic Internal Carotid Artery Occlusion, Thrombectomy

  • Marta Aguilar PérezEmail author
  • Muhammad AlMatter
  • Hans Henkes
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Abstract

A giant fusiform aneurysm of the petrous segment of the right internal carotid (ICA) artery was diagnosed in a 52-year-old woman, who presented with headache. Balloon test occlusion of the right ICA was clinically tolerated, yet the venous phase of the right anterior circulation after injection of the left ICA opacified with delay. The continuity of the right ICA was reconstructed with three Pipeline flow diverters (Medtronic) in September 2012. From there on, the patient was under dual platelet function inhibition by a medication with 1× 100 mg acetylsalicylic acid (Aspirin, Bayer Vital) and 2× 90 mg ticagrelor (Brilique, AstraZeneca) daily. Subsequent examinations showed that the aneurysm was not completely isolated from the blood circulation. A balloon expandable drug-eluting stent and an additional 12 flow diverters (10× p64 (phenox), 2× PEDs) were implanted into the petrous segment of the right ICA in the subsequent treatment sessions. In October 2015, a de novo stenosis of the proximal right ICA was treated by stent angioplasty. The patient had been asymptomatic for the last 5 years, when she then presented with an episode of headache, visual disturbance of her right eye, and fatigue on September 10, 2017. MRI showed an occlusion of the right ICA at the level of the implanted stents and flow diverters. CT perfusion (CTP) revealed an exhausted reserve capacity of the right anterior circulation. The Multiplate test (Roche) confirmed that the ASA effect was insufficient. The patient had taken the prescribed medication as usual, however, on September 5, 2017, she had a tooth extraction; on the following 5 days she had consumed a cumulative dosage of 10 g of metamizole. The onset of her neurological symptoms was on September 9, 2017. The recanalization of the right ICA was achieved by combining aspiration and mechanical thrombectomy on September 13, 2017. MRI showed minor ischemic lesions of the dependent right hemisphere. Follow-up DSA 1 week later confirmed the patency of the right ICA and on CTP the concerning reserve capacity was restituted. The flow diverter treatment of fusiform aneurysms and the interaction between metamizole and ASA are the main topics of this report.

Keywords

Petrous internal carotid artery Fusiform aneurysm Giant aneurysm Flow diversion Endoleak Reserve capacity Thrombectomy ASA interaction 

References

  1. Abud DG, Spelle L, Piotin M, Mounayer C, Vanzin JR, Moret J. Venous phase timing during balloon test occlusion as a criterion for permanent internal carotid artery sacrifice. AJNR Am J Neuroradiol. 2005;26(10):2602–9.PubMedGoogle Scholar
  2. Bhogal P, Pérez MA, Ganslandt O, Bäzner H, Henkes H, Fischer S. Treatment of posterior circulation non-saccular aneurysms with flow diverters: a single-centerexperience and review of 56 patients. J Neurointerv Surg. 2017 9(5):471-481.  https://doi.org/10.1136/neurintsurg-2016-012781.CrossRefGoogle Scholar
  3. Briganti F, Napoli M, Tortora F, Solari D, Bergui M, Boccardi E, Cagliari E, Castellan L, Causin F, Ciceri E, Cirillo L, De Blasi R, Delehaye L, Di Paola F, Fontana A, Gasparotti R, Guidetti G, Divenuto I, Iannucci G, Isalberti M, Leonardi M, Lupo F, Mangiafico S, Manto A, Menozzi R, Muto M, Nuzzi NP, Papa R, Petralia B, Piano M, Resta M, Padolecchia R, Saletti A, Sirabella G, Bolgè LP. Italian multicenter experience with flow-diverter devices for intracranialunruptured aneurysm treatment with periprocedural complications–a retrospective data analysis. Neuroradiology. 2012 54(10):1145-52.  https://doi.org/10.1007/s00234-012-1047-3.CrossRefGoogle Scholar
  4. Gelber BR, Sundt TM Jr. Treatment of intracavernous and giant carotid aneurysms by combined internal carotid ligation and extra- to intracranial bypass. J Neurosurg. 1980;52(1):1–10.CrossRefGoogle Scholar
  5. Gratzl O, Schmiedek P, Spetzler R, Steinhoff H, Marguth F. Clinical experience with extra-intracranial arterial anastomosis in 65 cases. J Neurosurg. 1976;44(3):313–24.CrossRefGoogle Scholar
  6. Gross BA, Moon K, Ducruet AF, Albuquerque FC. A rare but morbid neurosurgical target: petrous aneurysms and their endovascular management in the stent/flow diverter era. J Neurointerv Surg. 2017;9(4):381-383.  https://doi.org/10.1136/neurintsurg-2016-012668.CrossRefGoogle Scholar
  7. Hauck EF, Welch BG, White JA, Replogle RE, Purdy PD, Pride LG, Samson D. Stent/coil treatment of very large and giant unruptured ophthalmic and cavernous aneurysms. Surg Neurol. 2009;71(1):19-24; discussion 24.  https://doi.org/10.1016/j.surneu.2008.01.025.CrossRefGoogle Scholar
  8. Klisch J, Turk A, Turner R, Woo HH, Fiorella D. Very late thrombosis of flow-diverting constructs after the treatment of large fusiform posterior circulation aneurysms. AJNR Am J Neuroradiol. 2011;32(4):627-32.  https://doi.org/10.3174/ajnr.A2571.CrossRefGoogle Scholar
  9. Liu JK, Gottfried ON, Amini A, Couldwell WT. Aneurysms of the petrous internal carotid artery: anatomy, origins, and treatment. Neurosurg Focus. 2004;17(5):E13.CrossRefGoogle Scholar
  10. Meek IL, Vonkeman HE, Kasemier J, Movig KL, van de Laar MA. Interference of NSAIDs with the thrombocyte inhibitory effect of aspirin: a placebo-controlled, ex vivo, serial placebo-controlled serial crossover study. Eur J Clin Pharmacol. 2013;69(3):365-71.  https://doi.org/10.1007/s00228-012-1370-y.CrossRefGoogle Scholar
  11. Polzin A, Hohlfeld T, Kelm M, Zeus T. Impairment of aspirin antiplateleteffects by non-opioid analgesic medication. World J Cardiol. 2015;7(7):383-91.  https://doi.org/10.4330/wjc.v7.i7.383.CrossRefGoogle Scholar
  12. Puffer RC, Piano M, Lanzino G, Valvassori L, Kallmes DF, Quilici L, Cloft HJ, Boccardi E. Treatment of cavernous sinus aneurysms with flow diversion: results in 44 patients. AJNR Am J Neuroradiol. 2014;35(5):948-51.  https://doi.org/10.3174/ajnr.A3826.CrossRefGoogle Scholar
  13. Saatci I, Cekirge HS, Ozturk MH, Arat A, Ergungor F, Sekerci Z, Senveli E, Er U, Turkoglu S, Ozcan OE, Ozgen T. Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with mid-term follow-up results. AJNR Am J Neuroradiol. 2004;25(10):1742–9.PubMedGoogle Scholar
  14. Skukalek SL, Winkler AM, Kang J, Dion JE, Cawley CM, Webb A, Dannenbaum MJ, Schuette AJ, Asbury B, Tong FC. Effect of antiplatelet therapy and platelet function testing on hemorrhagic and thrombotic complications in patients with cerebral aneurysms treated with the pipeline embolization device: a review and meta-analysis. J Neurointerv Surg. 2016;8(1):58-65.  https://doi.org/10.1136/neurintsurg-2014-011145.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Marta Aguilar Pérez
    • 1
    Email author
  • Muhammad AlMatter
    • 1
  • Hans Henkes
    • 1
  1. 1.Neuroradiologische KlinikNeurozentrum, Klinikum StuttgartStuttgartGermany

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