Leveron&Nexovas
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 2147  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (988 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed274    
    Printed6    
    Emailed0    
    PDF Downloaded4    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
NEUROIMAGE
Year : 2022  |  Volume : 70  |  Issue : 2  |  Page : 814-815

Endovascular Treatment of a Giant Intracranial Aneurysm: Long-Term Imaging Follow-Up and Potential Risks


1 Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey
2 Department of Neurosurgery, Erciyes University School of Medicine, Kayseri, Turkey

Date of Submission02-Jan-2021
Date of Decision20-Jan-2021
Date of Acceptance29-Mar-2021
Date of Web Publication3-May-2022

Correspondence Address:
Izzet Okcesiz
Department of Radiology, Erciyes University School of Medicine, Kayseri
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.344624

Rights and Permissions



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 Jun 25];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

Click here to view
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)

Click here to view


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.[1] 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)

Click here to view


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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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.  Back to cited text no. 1
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow