A different endovascular technique in multiple brain aneurysms

Find out how Dr Chingiz Nurimanov treated a 58-year-old female patient with multiple intracranial aneurysms.

Case presentation

Clinical information

A 58-year-old female patient

Chief complaint: right third cranial nerve palsy
History: SAH 2 years ago
Examination: MRI and DSA
Diagnosis: multiple intracranial aneurysms

Diagnosis

Ruptured aneurysms of the basilar artery (BA)-ASC junction. Unruptured aneurysms of both sides of the MSA bifurcation. Unruptured aneurysm of the right ICA bifurcation. Unruptured aneurysm of the left ICA.

DSA images

Unruptured right MSA bifurcation aneurysms. Unruptured right ICA bifurcation aneurysm.

Follow-up after 12 months. Clipped right MCA aneurysm. Balloon-assisted embolized aneurysm of right ICA bifurcations.

MSA bifurcation aneurysms, ICA aneurysm & Follow up

Unruptured left MSA bifurcation aneurysms. Unruptured left ICA aneurysm.

Follow-up after 12 months. Balloon-assisted embolized aneurysm of left ICA.

Basilar artery (BA)-SCA junction

Procedure

Procedure

The patient received oral aspirin (300 mg) and Ticagrelor (180 mg) 4 hours before the operation and 5000 U of heparin was used during the operation.

Two 6 French Envoy MPC guiding systems were placed in the V2 segment of the left vertebral artery (VA) and the ascending cervical segment of the right ICA by bilateral femoral puncture. The Echelon microcatheter was passed through the right PcoM through the aneurysm, guided by a Synchro guide wire to the right SCA.

Deployment (LVIS Jr Device 2.5 х 23 mm ) from P1 to BA; Aneurysm packed with 4 detachable coils with stent-jail technique.

Follow-up after 12 months

Conclusion

Endovascular and microsurgical therapies are considered complementary, rather than competing techniques for the management of multiple intracranial aneurysms.
Endovascular technique is a preferable and safe option in the treatment of posterior circle aneurysm.