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Rapid documented growth of aneurysm bleb led to rupture of an incidental intracranial anterior communicating artery (Acom) aneurysm


Burkhardt, Jan-Karl; Fierstra, Jorn; Esposito, Giuseppe; Baltsavias, Gerasimos; Bozinov, Oliver; Regli, Luca (2017). Rapid documented growth of aneurysm bleb led to rupture of an incidental intracranial anterior communicating artery (Acom) aneurysm. Central European neurosurgery, 78(05):521-524.

Abstract

Background A major challenge in the management of patients with unruptured intracranial aneurysms (UIAs) is the identification of criteria indicating a higher risk of future UIA rupture. Here we report a rare patient with documented short-term bleb growth of an UIA followed by fatal aneurysm rupture supporting the high-risk of rupture of short-term shape changes in UIAs. Case description A 72 year old man with an incidental unruptured anterior communicating artery aneurysm of 9 mm showed a bleb growth on the aneurysm sac at a 6 week follow-up CTA. Aneurysm treatment was recommended by the interdisciplinary board (PHASES score: 9 points, rupture risk 4.3%/5years). The patient wanted to discuss treatment plan with his family before final decision for treatment. Two days after the CTA showing bleb grwoth he was admitted emergently with a severe SAH (WFNS 5, Fisher 3). The aneurysm was occluded with coils. However, the patient died on day 14 after SAH due to delayed ischemic neurological deficits and multiple organ failure. Conclusions This case illustrates the high rupture risk of an UIA presenting a documented growth of an aneurysm bleb over a short follow-up time. In retrospect, this patient might have benefitted from emergent aneurysm occlusion. The interest of this report comes from the prove that aneurysmal bleb growth constitutes a high risk for short-term aneurysm rupture.

Abstract

Background A major challenge in the management of patients with unruptured intracranial aneurysms (UIAs) is the identification of criteria indicating a higher risk of future UIA rupture. Here we report a rare patient with documented short-term bleb growth of an UIA followed by fatal aneurysm rupture supporting the high-risk of rupture of short-term shape changes in UIAs. Case description A 72 year old man with an incidental unruptured anterior communicating artery aneurysm of 9 mm showed a bleb growth on the aneurysm sac at a 6 week follow-up CTA. Aneurysm treatment was recommended by the interdisciplinary board (PHASES score: 9 points, rupture risk 4.3%/5years). The patient wanted to discuss treatment plan with his family before final decision for treatment. Two days after the CTA showing bleb grwoth he was admitted emergently with a severe SAH (WFNS 5, Fisher 3). The aneurysm was occluded with coils. However, the patient died on day 14 after SAH due to delayed ischemic neurological deficits and multiple organ failure. Conclusions This case illustrates the high rupture risk of an UIA presenting a documented growth of an aneurysm bleb over a short follow-up time. In retrospect, this patient might have benefitted from emergent aneurysm occlusion. The interest of this report comes from the prove that aneurysmal bleb growth constitutes a high risk for short-term aneurysm rupture.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:anterior communicating artery aneurysm, aneurysm bleb, aneurysm bleb growth
Language:English
Date:2017
Deposited On:31 Jan 2017 14:05
Last Modified:12 Aug 2017 13:36
Publisher:Georg Thieme Verlag
ISSN:1868-4904
Additional Information:case report
Publisher DOI:https://doi.org/10.1055/s-0037-1598053
PubMed ID:28183143
Other Identification Number:CEN-2016-09-CR-1776-R1

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