Acute treatment of a ruptured cerebral aneurysm with a flow-diverter stent

Discover the case of a 66-year-old male patient who presented with acute subarachnoid hemorrhage. Although initial imaging did not reveal an aneurysm, further examination identified a ruptured "blister" aneurysm of the basilar artery. To address this complex morphology, a flow-diversion stent was placed, with the administration of Cangrelor to manage the thrombotic risks associated with the procedure.

Case presentation

Patient presentation

66-year-old male patient presenting with acute onset headache.
Emergency brain CT scan (A) showed subarachnoid hemorrhage in the peri-mesencephalic cistern.

Intervention

CT angiography

with MIP (B) and arterial phase (C) reconstructions showed no aneurysmal changes; only in the venous phase (D) there was a suspected small "blister" aneurysm of the basilar artery (arrow).

E-F) DynaCT examination (VR) demonstrates a small aneurysmal sac originating from a perforating artery (arrow). G) DSA after placement of Flow-Diverter in the same procedure, administering Cangrelor ev. H) MIP reconstruction of baseline DynaCT confirming the correct positioning of the FD from the right P1 segment to the basilar artery.

MR Angiography control (TOF)

after 1 (I) and 6 (J) months showing patency of the posterior circulation, without signs of perfusion of the cerebral aneurysm.

Conclusion

In this case the use of Cangrelor in an acute setting ensured to correctly treat a patient who required acute flow-diverter stent placement for a ruptured aneurysm with complex morphology, not otherwise treatable.
This drug has a rapid "onset" and "offset", thanks to its short half-life, which could be useful in complex cases where high bleeding and thrombotic risks coexist.