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1.
J Neurointerv Surg ; 12(9): e7, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32571962

ABSTRACT

We report the case of a patient with subarachnoid hemorrhage and three aneurysms arising from the posterior communicating artery (Pcomm)-P1 complex, treated with endovascular coiling and competitive flow diversion. The largest and likely ruptured Pcomm aneurysm was treated with traditional coiling. Two smaller potentially ruptured aneurysms arose from the distal right posterior cerebral artery (PCA) P1 segment. After a failed attempt to treat with conventional flow diversion across the PCA-P1 segment, the P1 aneurysms were successfully treated with competitive flow diversion distal to the PCA-P1 segment from Pcomm to the P2 segment. Over 12 months, competitive flow diversion redirected flow to the right PCA territory via the internal carotid artery-Pcomm-P2, reducing the size of the PCA-P1 segment and obliterating the P1 aneurysms. Competitive flow diversion treatment should be considered for aneurysms occurring at the circle of Willis when traditional methods are not feasible. Herein, we introduce a novel classification for competitive flow diversion treatment.


Subject(s)
Aneurysm, Ruptured/classification , Aneurysm, Ruptured/therapy , Intracranial Aneurysm/classification , Intracranial Aneurysm/therapy , Aneurysm, Ruptured/diagnostic imaging , Embolization, Therapeutic/classification , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Female , Humans , Intracranial Aneurysm/diagnostic imaging , Middle Aged , Retrospective Studies , Subarachnoid Hemorrhage/classification , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/therapy , Treatment Outcome
2.
BMJ Case Rep ; 13(6)2020 Jun 03.
Article in English | MEDLINE | ID: mdl-32499293

ABSTRACT

We report the case of a patient with subarachnoid hemorrhage and three aneurysms arising from the posterior communicating artery (Pcomm)-P1 complex, treated with endovascular coiling and competitive flow diversion. The largest and likely ruptured Pcomm aneurysm was treated with traditional coiling. Two smaller potentially ruptured aneurysms arose from the distal right posterior cerebral artery (PCA) P1 segment. After a failed attempt to treat with conventional flow diversion across the PCA-P1 segment, the P1 aneurysms were successfully treated with competitive flow diversion distal to the PCA-P1 segment from Pcomm to the P2 segment. Over 12 months, competitive flow diversion redirected flow to the right PCA territory via the internal carotid artery-Pcomm-P2, reducing the size of the PCA-P1 segment and obliterating the P1 aneurysms. Competitive flow diversion treatment should be considered for aneurysms occurring at the circle of Willis when traditional methods are not feasible. Herein, we introduce a novel classification for competitive flow diversion treatment.


Subject(s)
Aneurysm, Ruptured , Cerebrovascular Circulation/physiology , Circle of Willis , Computed Tomography Angiography/methods , Endovascular Procedures , Intracranial Aneurysm , Stents , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/surgery , Cerebral Angiography/methods , Circle of Willis/diagnostic imaging , Circle of Willis/physiopathology , Circle of Willis/surgery , Endovascular Procedures/instrumentation , Endovascular Procedures/methods , Female , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Middle Aged , Posterior Cerebral Artery/diagnostic imaging , Posterior Cerebral Artery/pathology , Posterior Cerebral Artery/surgery , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/physiopathology , Subarachnoid Hemorrhage/therapy , Therapies, Investigational , Treatment Outcome
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