E-009 Dissecting Ruptured and Symptomatic Intracranial Pseudo-aneurysm who Underwent Endovascular Repair-A Case Series

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Abstract

Background

The natural history of intracranial dissecting pseudo-aneurysm is not known. The optimum treatment strategies are not defined. The recent case series demonstrated non favorable clinical outcome when endovascular pipeline device was utilised to treat intracranial dissection aneurysm.

Objectives

To describe the treatment modalities that were undertaken to treat our series of ruptured and symptomatic intracranial dissection aneurysm. Additionally, we like to report the clinical and radiographic outcome for our case series.

Methods

Retrospective analysis of all dissecting intracranial aneurysms that underwent endovascular repair from January 2008 to December 2013. Patient demographics including aneurysm morphology and endovascular treatment modalities including angiographic data were collected. Clinical outcome was measures using modified Rankin Scale score (mRS).

Results

Six patients with median age of 58 year old (range 38–71), 5 women and one man with dissecting intracranial aneurysm were treated in endovascular approach. Off 6 patients, 3 were ruptured and 3 symptomatic; 4 spontaneous, one immediate post craniotomy and one suspected post motor vehicle accident. Three aneurysms were located in the internal carotid artery (ICA) petro-cavernous portion, one in ICA-supraclinoid, one in the right Vertebral artery (VA) and one in left VA-posterior inferior artery. Endovascular strategies utilised; 3 required stent-assisted (Enterprise) coiling, one Stenting only and two primary coiling. There was no intra-operative or post-operative event. Recurrence was observer in 4 of 6 cases and all in the ICA territories; of which 3 underwent successful recoiling including one required placement of an additional stent. Endovascular therapy to the one recurrent case couldn’t be performed due to remodeling induced extreme angulation of the pre-existing deformed left internal carotid artery that required stent-assisted repair of the proximal cervical internal carotid artery symptomatic dissecting aneurysm at the time of the repair of ICA-petrous dissecting aneurysm. The failed case underwent open craniotomy with external to internal carotid artery bypass surgery resulting in malignant stroke and death. Good outcome was observed in 5 cases (mRS 0 in 3, mRS 1 in 1). Poor outcome was observed in I (mRS 6).

Conclusions

Our series demonstrates that dissecting intracranial aneurysm is predominantly present in the Petro-Cavernous junction of the ICA. Most of them could be treated successfully with good clinical outcome using stent-assisted coiling, stent-remodeling or primary coiling. However, the recurrence rate is extremely common; therefore close early follow-up is necessary for all cases especially those located in Petro-cavernous junction of the ICA. Further long-term follow-up study is required.

Disclosures

Y. Lodi: None. V. Reddy: None. A. Devasenapathy: None. J. Chou: None. K. Shehades: None. K. Sethi: None. D. Galyon: None. S. Bajwa: None.

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