RESUMO
Endovascular treatment of intracranial aneurysms is increasingly used and has evolved as an alternative to surgical clipping. However, its long-term efficacy has yet to be established. This retrospective hospital based (tertiary teaching hospital) study aimed to identify factors that might be important in predicting initial efficacy of this treatment and a long-term follow-up to study the clinical and angiographic results of treated aneurysms. A total of 80 aneurysms in 78 patients were treated and analyzed, and the percentage of occlusion calculated. Overall, 51/80 (64 %) cases were treated with selective endovascular coil occlusion and 29/80 (36 %) by parent artery occlusion. The shape of the aneurysm rest was noted on the immediate post treatment and follow-up angiograms. Immediate and follow-up clinical status was also noted using the Glasgow outcome scale. The clinical and radiological changes on follow-up were assessed and possible factors involved were analyzed. Of the 50 patients of intracranial aneurysms that underwent selective aneurysm coiling, good immediate outcome (Glasgow outcome scale 1 and 2) was seen in 36/50 (72 %) cases. Narrow necked aneurysms showed a good immediate result (90-100 % packing) in all cases 28/28 (100 %). Amongst the wide necked aneurysms, good packing (90-100 %) was achieved in 17/23 (73 %) cases. Amongst the cases treated with parent artery occlusion, complete occlusion was noted in 20/29 (69 %) cases. No subarachnoid hemorrhage was seen in any of the followed up cases of coiled aneurysms. A statistically significant relationship was noted between aneurysm neck size and immediate angiographic outcome. Long-term angiographic recurrences were found more often in large aneurysms. Endovascular treatment of intracranial aneurysms is a safe and effective treatment modality that offers protection from recurrent subarachnoid hemorrhage.
RESUMO
SUMMARY: A rare case of multiple cerebral aneurysms associated with Takayasu aortitis is reported. Only seven cases have been reported so far, all of which are from Japan. This is the first case with this association being reported from India. A 50-year-old hypertensive woman developed sudden onset severe headache and loss of consciousness. CT scan revealed subarachnoid haemorrhage in the suprasellar cisterns and mild hydrocephalus. The patient on admission had a rebleed producing a massive subarachnoid haemorrhage. Angiogram revealed occlusion of bilateral vertebral arteries and right common carotid artery. The left carotid artery was ectatic with saccular aneurysms in the ophthalmic segment and communicating segment. Aortogram showed the radiological picture of Takayasu arteritis Type III. Surgical clipping of the aneurysms was performed. However, the patient developed a massive right cerebral infarct in the postoperative period following which she expired. Abnormal haemodynamics in the overloaded cerebral circulation rather than primary arteritic involvement of intracranial vessels appears to be the cause of aneurysm formation.
