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Year : 2022  |  Volume : 70  |  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

Correspondence Address:
Izzet Okcesiz
Department of Radiology, Erciyes University School of Medicine, Kayseri
Turkey




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;70:814-815


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 Aug 11 ];70:814-815
Available from: https://www.neurologyindia.com/text.asp?2022/70/2/814/344624


Full Text



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}{Figure 2}

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}

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

1Khan 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.