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Internal Carotid Artery Aneurysm: Multiple Internal Carotid Artery Aneurysms in a Patient Presenting with Subarachnoid Hemorrhage; Treatment with Flow Diverter Stents

  • José E. CohenEmail author
  • Asaf Honig
  • Gustavo Rajz
Living reference work entry

Abstract

Up to 30% of patients presenting with acute aneurysmal hemorrhage are found to have multiple aneurysms. As the determination of the source of the bleeding may not be straightforward in the cases of multiple aneurysms, the simultaneous treatment of all aneurysms is often considered. We present the case of a 41-year-old woman with an unremarkable medical history apart from chronic headaches, who presented with a left-sided basal subarachnoid hemorrhage (SAH; Hunt and Hess II, Fisher grade III). Neuroradiological examinations, including CT and CT angiography (CTA), revealed a midsized carotid ophthalmic aneurysm at the left internal carotid artery (ICA). Angiography confirmed the diagnosis of the ophthalmic aneurysm and depicted two other small aneurysms on the posterior communicating (PcomA) and anterior choroidal (AchoA) arteries. An external ventricular drain was inserted and the patient was given loading doses of aspirin and prasugrel. All three aneurysm ostia were completely covered by the implantation of two telescoping flow diverter stents in a single uneventful procedure. The ventriculostomy was removed after day 7 and the patient was discharged home after 12 days. Follow-up head CT at days 5 and 10 showed no hydrocephalus. Follow-up angiography at 3 months confirmed occlusion of all three left ICA aneurysms. Prasugrel was discontinued at month 4 and aspirin was continued indefinitely. The safety and effectiveness of flow diverter stent implantation in the management of multiple carotid aneurysms, including the less-explored situation of multiple aneurysms presenting with SAH, is the main topic of this chapter.

Keywords

Internal carotid artery Flow diverter stent Multiple aneurysms Subarachnoid hemorrhage 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryHadassah-Hebrew University Medical CenterJerusalemIsrael
  2. 2.Department of NeurosurgeryShaare Zedek Medical CenterJerusalemIsrael

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