Endovascular management of Intracranial
aneurysms is gaining popularity worldwide. It is especially useful in the
management of Cerebral Aneurysms that are difficult to access or whose surgery
has a high morbidity rate. It is also very useful in elderly patients and
patients who are in a poor neurological state.
Microcatheters placed in the carotid and
vertebral arteries through the femoral route outline the aneurysm and then
deliver coils which are placed into the aneurysmal sac. The size and
configuration of the aneurysm determines the number and type of coils used.
A 65 year old lady presented with repeated
attacks of unawareness and loss of vision suggestive of TIA and TMB. An MRI
with MR angiogram revealed an Internal Carotid artery aneurysm. A Digital
Subtraction Angiogram (DSA) was done which showed the aneurysm to be arising
from the ventral wall of the Cavernous Sinus segment of the ICA. Embolisation
of the Aneurysm using 3D coils was performed after placing a balloon across the
neck of the aneurysm to prevent distal embolus of the coil.
The procedure was successful with the
post-coiling angiogram showing complete obliteration of the aneurysm.
The lady was discharged three days after
the procedure without any symptoms or deficits.
Special points of interest
- Aneurysms can present in many ways including TIA
- All symptomatic aneurysms and some incidental aneurysms require treatment
- The choice of management between surgery and endovascular management depends on many factors
- A microcatheter placed in the carotid and vertebral arteries through the femoral route helps delineate the configuration of the aneurysm
- The size and configuration of the aneurysm decides the type and number of coils used
- It is essential that the Neurosurgical team be on stand by during the pro-cedure in case of any eventuality