Features of endovascular treatment of ruptured saccular aneurysms of the anterior cerebral circulation in the hemorrhagic period against the background of stenosis of the internal carotid artery
Abstract
Objective – to determine the optimal tactics for endovascular occlusion of an aneurysm of the anterior cerebral circulation against the background of stenosis of the internal carotid artery (ICA) of different degrees in the hemorrhagic period of complicated intracranial hemorrhage.
Materials and methods. The results of endovascular embolization of intracranial ruptured aneurysms on the background of concomitant stenosis of the ipsilateral ICA have been analyzed. The degree of stenosis was evaluated according to NASCET criteria when performing digital selective angiography. All patients underwent standard multispiral computed tomography examination and in some cases magnetic resonance imaging in both hemorrhagic and long-term hemorrhage. In 4 out of 5 cases there was a rupture of the saccular aneurysm of the anterior cerebral artery. In all cases of stenosis of small degree or moderate stenosis, isolated occlusion of the aneurysm with detachable coils was performed, in cases with hemodynamically significant stenosis of the ICA (more than 70 %), single-session stenting of the ICA using distal protection and embolization of the aneurysm was performed. In cases of one-session stenting and embolization of aneyrysm, patients received double disaggregant therapy. With one-session intervention, the first stage was performed – stenting of the ICA orifice using distal protection. The second stage performed endovascular embolization of aneurysm by detachable coils.
Results. In all cases, a good angiographic result of aneurysm occlusion (Raymond 1) and stenting was noted at both the end of the intervention and the follow-up examinations at 3 months and a year. Complications associated with stent implantation and the use of double disaggregant therapy were also not noted. In the case of an aneurysmal hemorrhage complicated by angiospasm, against the background of a moderate degree of carotid stenosis, development of a secondary ischemic stroke was noted.
Conclusions. One-session carotid stenting and embolization of aneurysm in combined lesions of the ICA basin in the acute period of complicated aneurysmal hemorrhage is a method of choice. In cases of angiospasm complication of the course of an aneurysmal hemorrhage against a background of moderate degree of carotid stenosis, the indications for carotid stenting may be extended.
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References
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