Rapid Documented Growth of Aneurysm Bleb Led to Rupture of an Incidental Intracranial Anterior Communicating Artery Aneurysm
Rapid Documented Growth of Aneurysm Bleb Led to Rupture of an Incidental Intracranial Anterior Communicating Artery Aneurysm
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DOI：
10.1055/s-0037-1598053
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发表时间：
2017-09-01
影响因子：
1
通讯作者：
Regli, Luca
中科院分区：
文献类型：
--
作者：
Burkhardt, Jan-Karl;Fierstra, Jorn;Regli, Luca
背景：治疗未破裂的颅内动脉瘤(UIA)患者的一个主要挑战是确定表明UIA未来破裂风险较高的标准。我们报告一位罕见的患者，记录有UIA的短期泡状生长，随后发生致命性动脉瘤破裂，支持UIA短期形态改变破裂的高风险。病例描述：72岁男性，偶发的未破裂的前交通动脉动脉瘤，直径9 mm，在6周的计算机断层血管摄影(CTA)随访中显示动脉瘤囊上有泡状生长。动脉瘤治疗由跨学科委员会推荐(分期评分：9分；5年破裂风险为4.3%)。患者希望在做出最终决定之前与家人讨论治疗计划。在CTA显示水泡生长的两天后，他因严重的蛛网膜下腔出血(SAH)而急诊入院(世界神经外科医生联合会5级；Fisher 3级)。动脉瘤被弹簧圈堵住了。然而，患者在SAH后第14天死亡，原因是迟发性缺血性神经功能障碍和多器官功能衰竭。结论此病例说明UIA破裂的风险很高，在很短的随访时间内表现为动脉瘤气泡的生长。回想起来，这位患者可能是从急诊动脉瘤闭塞中受益的。这份报告的兴趣来自于有证据表明，动脉瘤样泡的生长构成了短期动脉瘤破裂的高风险。
Background A major challenge in the management of patients with unruptured intracranial aneurysms (UIAs) is to identify criteria indicating a higher risk of future UIA rupture. We report a rare patient with documented short-term bleb growth of an UIA followed by a fatal aneurysm rupture supporting the high risk of rupture of short-term shape changes in UIAs.Case Description A 72-year-old man with an incidental unruptured anterior communicating artery aneurysm of 9mm showed a bleb growth on the aneurysm sac at 6-week follow-up computed tomography angiography (CTA). Aneurysm treatment was recommended by the interdisciplinary board (PHASES score: 9 points; rupture risk 4.3% in 5 years). The patient wanted to discuss the treatment plan with his family before making a final decision. Two days after the CTA showing bleb growth, he was admitted emergently with a severe subarachnoid hemorrhage (SAH) (World Federation of Neurologic Surgeons grade 5; Fisher 3). The aneurysm was occluded with coils. However, the patient died on day 14 after SAH due to delayed ischemic neurologic deficits and multiple organ failure.Conclusions This case illustrates the high rupture risk of an UIA presenting a documented growth of an aneurysm bleb over a short follow-up time. In retrospect, this patient might have benefited from emergent aneurysm occlusion. The interest of this report comes from the proof that aneurysmal bleb growth constitutes a high risk for short-term aneurysm rupture.