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Ruptured Cerebral Aneurysms - Treatment by Endovascular Techniques (Embolization)

Background:

A cerebral aneurysm is a small sac that develops as an outpouching from an artery on the surface of the brain. These aneurysms have the potential to rupture into the fluid spaces surrounding the brain. Rupture of an aneurysm can result in death or a stroke. If there is only a small bleed patients can be successfully treated to prevent a second bleed. If aneurysms are detected before bleeding then treatment of the aneurysm would be aimed at preventing future bleeds. Aneurysm treatment includes surgical and catheter techniques (endovascular treatment). Some aneurysms can be effectively treated by either method. Some aneurysms are best treated by one of these techniques.

Case Example:  

A thirty-eight year old male presented to the emergency department with the worst headache of his life. He was confused but moving all limbs. A computed tomography (CT) of the brain showed blood in the fluid spaces around the brain. An angiogram showed a cerebral aneurysm (Figure 1) that was suitable for either surgical or catheter treatment. The catheter technique was used.

Pre-treatment:

Cerebral angiogram shows the aneurysm (arrows) that was responsible for the bleed.

Treatment:

#3D reconstruction of the angiogram show the saccular nature of the aneurysm (arrows).

   

Angiogram shows the position of the first coil (green arrow). The microcatheter (yellow arrows) used to deliver the coils can be seen within the arteries.

Post-Treatment:

Angiogram after treatment shows that the aneurysm no longer fills with blood.

Clinical Follow-up:

The patient's headaches and confusion resolved over the next month. He was back to work and had resumed full activity 3 months after the treatment.