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|Year : 2022 | Volume
| Issue : 2 | Page : 814-815
Endovascular Treatment of a Giant Intracranial Aneurysm: Long-Term Imaging Follow-Up and Potential Risks
Izzet Okcesiz1, Halil Dönmez1, Nevzat Herdem1, Halil Ulutabanca2
1 Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey
2 Department of Neurosurgery, Erciyes University School of Medicine, Kayseri, Turkey
|Date of Submission||02-Jan-2021|
|Date of Decision||20-Jan-2021|
|Date of Acceptance||29-Mar-2021|
|Date of Web Publication||3-May-2022|
Department of Radiology, Erciyes University School of Medicine, Kayseri
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Okcesiz I, Dönmez H, Herdem N, Ulutabanca H. Endovascular Treatment of a Giant Intracranial Aneurysm: Long-Term Imaging Follow-Up and Potential Risks. Neurol India 2022;70:814-5
|How to cite this URL:|
Okcesiz I, Dönmez H, Herdem N, Ulutabanca H. Endovascular Treatment of a Giant Intracranial Aneurysm: Long-Term Imaging Follow-Up and Potential Risks. Neurol India [serial online] 2022 [cited 2022 Jul 3];70:814-5. Available from: https://www.neurologyindia.com/text.asp?2022/70/2/814/344624
A 55-year-old female patient with severe headache and nausea was admitted to the emergency service. Cranial magnetic resonance imaging (MRI) showed a 43 × 42 × 44 mm sized giant intracranial aneurysm (GIA) that originated left middle cerebral artery (MCA) bifurcation with a prominent thrombosed component, causing severe vasogenic edema and midline shift [Figure 1].
Preprocedural angiographic evaluation confirmed that GIA [Figure 2]a and the patient underwent Y-stent- assisted coil embolization [Figure 2]b. Post-procedural 1st month, 3rd month, 6th month, 1 year, then annual cranial MRI and angiographic follow-up were performed for 5 years.
|Figure 1: Axial (a) and coronal (b) magnetic resonance imaging (MRI) figures demonstrated a giant intracranial aneurysm (arrows) that originated left middle cerebral artery (MCA) bifurcation, causing severe vasogenic edema (arrowheads) and midline shift|
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|Figure 2: Anterior-posterior digital substraction angiographic view of giant middle cerebral artery aneurysm: Pre-procedural (a), Post-procedural (b) and 5th-year control (c)|
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During the follow-up period, there was no recanalization was observed in the giant aneurysm lumen [Figure 2]c. However, the size and configuration of the aneurysm did not change markedly and contrast enhancement of the thrombosed component of the aneurysm and the aneurysm wall, T2-weighted hyperintensities in the perianeurysmal cerebral parenchyma consistent with vasogenic edema-gliosis were observed. These MRI findings had shown a slight regression in the follow-up period but did not clear away completely [Figure 3]. Khan et al. demonstrated the association between the arterial wall enhancement and rupture risk with hemodynamic and morphological factors. Although the post-procedural first six months is a more critical period with marked enhancement, in this case, the patient's follow-up is being continued up to 5 years because of the persistence of contrast enhancement predicting the risk of rupture.
|Figure 3: MRI follow-up: First line (a-d) 1st month, 6th month, 1st year, and 5th-year axial T2W images, second line (e-h) axial T1W contrast-enhanced images of the same examinations. The liquefied thrombus areas (arrows) gradually increased during the follow-up period. Especially on the 6th-month control MRI (f), severe inflammatory changes and marked contrast enhancement in the aneurysm wall and thrombosed component were observed. This changes regressed in the follow-up period but did not clear away completely (Arrowheads: Contrast enhancement of the aneurysm wall)|
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In conclusion, the treatment of GIAs is still a challenge. The dynamic inflammatory process, which increases the risk of rupture, keeps going for a long time in spite of successful endovascular treatment.
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Conflicts of interest
There are no conflicts of interest.
| » References|| |
Khan MO, Toro Arana V, Rubbert C, Cornelius JF, Fischer I, Bostelmann R, et al
. Association between aneurysm hemodynamics and wall enhancement on 3D vessel wall MRI. J Neurosurg 2020;10:1-11.
[Figure 1], [Figure 2], [Figure 3]