Multiple intracranial aneurysms with long-term follow-up: one case report

doi:10.3969/j.issn.1672-6731.2024.08.014

Abstract

Key words: Intracranial aneurysm, Embolization, therapeutic, Recurrence, Follow-up studies, Case reports

Shi-qiang WANG, Xiao-yan HE, Tao GENG, Chang-xing PENG. Multiple intracranial aneurysms with long-term follow-up: one case report[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(8): 689-694.

王时强, 何小燕, 耿涛, 彭昌兴. 颅内多发动脉瘤长期随访一例[J]. 中国现代神经疾病杂志, 2024, 24(8): 689-694.

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URL: http://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2024.08.014

http://journal11.magtechjournal.com/cjcnn/EN/Y2024/V24/I8/689

Figures/Tables 8

Figure 1 Before the first embolization, axial CT showed hematoma in the left fissure pool (arrow indicates).

Figure 2 DSA findings before and after the first embolization Anteroposterior DSA before embolization showed the 2 aneurysms in the M2 segment of left MCA were large in size and irregular in shape, which were considered as responsible aneurysms with relatively narrow neck (thin arrow indicates), while the aneurysm in the C5 segment of left ICA was small in size and regular in shape (thick arrow indicates, Panel 2a). Anteroposteric DSA immediately after embolization showed complete embolization of left MCA M2 aneurysms (arrow indicates, Panel 2b).

Figure 3 Follow-up imaging examination in April 2015 Preoperative lateral CTA showed left MCA M2 aneurysms no signs of recurrence, and left ICA C5 aneurysm with enlarged size, morphological changes and wide neck (arrows indicate, Panel 3a). Embolization of the left ICA C5 aneurysm with stent semi-release technique (arrow indicates, Panel 3b). Postoperative anteroposterior DSA immediately showed complete embolization of the left ICA C5 aneurysm (arrow indicates, Panel 3c). Postoperative anteroposterior DSA immediately showed smooth blood flow in the ACA and MCA (Panel 3d).

Figure 4 Follow-up CTA findings in December 2018 Frontal CTA showed the new right MCA M2 aneurysm and anterior communicating artery aneurysm (arrows indicate), and no signs of recurrence in embolized left MCA M2 aneurysms and left ICA C5 aneurysm (Panel 4a). Frontal CTA showed the right MCA M2 aneurysm and anterior communicating artery aneurysm (arrows indicate, Panel 4b).

Figure 5 Follow-up DSA findings in January 2019 Intraoperative anteroposterior DSA showed the right MCA M2 aneurysm (arrow indicates, Panel 5a). Intraoperative anteroposterior DSA showed anterior communicating artery aneurysm (arrow indicates, Panel 5b). Intraoperative anteroposterior DSA showed the right MCA M2 aneurysm was embolized with single catheter technique (arrow indicates, Panel 5c). Intraoperative anteroposterior DSA showed the anterior communicating artery aneurysm was embolized with double catheter technique (arrow indicates, Panel 5d). Postoperative anteroposterior DSA immediately showed complete embolization of the right MCA M2 aneurysm (arrow indicates, Panel 5e). Postoperative anteroposterior DSA immediately showed complete embolization of the anterior communicating artery aneurysm (arrow indicates, Panel 5f).

Figure 6 Follow-up in April 2019, frontal CTA showed no signs of recurrence in the left MCA M2, left ICA C5, right MCA M2, and anterior communicating artery aneurysms.

Figure 7 Follow-up imaging findings in April 2021 Frontal CTA before embolization showed increased volume of anterior communicating artery aneurysm, indicating signs of recurrence (arrow indicates, Panel 7a). Anteroposterior DSA before embolization showed no signs of recurrence in the right MCA M2 aneurysm (Panel 7b). Anteroposterior DSA before embolization showed signs of recurrence in the anterior communicating artery aneurysm (arrow indicates), and no signs of recurrence in the left MCA M2 aneurysms and left ICA C5 aneurysm (Panel 7c). Intraoperative anteroposterior DSA showed the anterior communicating artery aneurysm was embolized by single catheter technique (arrow indicates, Panel 7d). Postoperative anteroposterior DSA immediatehy showed the recurrent anterior communicating artery aneurysm was completely embolized (arrow indicates, Panel 7e).

Figure 8 Follow-up in March 2022 CTA showed no signs of recurrence in the left MCA M2, left ICA C5, right MCA M2, and anterior communicating artery aneurysms. Frontal CTA (Panel 8a). Oblique CTA (Panel 8b).

References 15

1	Bai JY , Meng QB , Wang ZB , Guan S . Conventional stent-assisted coil embolization for internal carotid artery-posterior communicating artery aneurysms: analysis of clinical results and recurrence factors. Jie Ru Fang She Xue Za Zhi, 2021, 30: 1095- 1099. URL
	白京岳, 孟庆斌, 王子博, 管生. 颈内动脉-后交通动脉瘤常规支架辅助弹簧圈栓塞治疗临床结果及复发因素分析. 介入放射学杂志, 2021, 30: 1095- 1099. URL
2	Zeng P , Gu Z , Chen H , Chen YY , Li YJ , Wang L , Wu J , Chen X . Large-sized coil technique versus traditional coil embolization in treating internal carotid arteryposterior communicating artery aneurysms: comparison of clinical effect. Jie Ru Fang She Xue Za Zhi, 2021, 30: 980- 984. URL
	曾平, 谷震, 陈红, 陈昱云, 李亚捷, 王磊, 吴键, 陈旭. 大弹簧圈技术与传统方式栓塞治疗颈内动脉-后交通动脉瘤临床效果对比分析. 介入放射学杂志, 2021, 30: 980- 984. URL
3	Wang HP , Xu X , Wang DY , Pei J , Zheng Y , Tian BG , Gao YH . Preliminary application of Neuroform Atlas stent-assisted coiling in the treatment of ruptured anterior communicating wide-necked aneurysms. Zhonghua Shen Jing Wai Ke Za Zhi, 2021, 37: 810- 814. URL
	王红平, 徐翔, 王大永, 裴剑, 郑宇, 田宝刚, 高云鹤. Neuroform Atlas支架辅助弹簧圈治疗破裂前交通动脉宽颈动脉瘤的初步应用. 中华神经外科杂志, 2021, 37: 810- 814. URL
4	Huang G , Sun Y , Liu J , Tong XG . Surgical treatment for recurrent intracranial aneurysms after primary interventional embolization. Zhongguo Xian Dai Shen Jing Ji Bing Za Zhi, 2021, 21: 575- 580. URL
	黄戈, 孙杨, 刘洁, 佟小光. 外科手术治疗初次介入栓塞术后复发颅内动脉瘤. 中国现代神经疾病杂志, 2021, 21: 575- 580. URL
5	Hou CK , Zhao Y , Yu JJ , Liu ZB , Wang LQ , Hu FG , Cui JZ , Zhang ZY , Ren XL , Li JH , Liu QG , Chen L , Chen S , Gao YK , Wang JJ , Yang XY . Clinical features, treatment methods and short-term outcomes of single and multiple intracranial aneurysms: a multicenter study. Zhonghua Shen Jing Wai Ke Za Zhi, 2021, 37: 331- 336.
	候长凯, 赵岩, 于建军, 刘振波, 王立群, 胡福广, 崔建忠, 张中原, 任新亮, 李建华, 刘庆国, 陈镭, 陈实, 高贻宽, 王建军, 杨新宇. 单发与多发颅内动脉瘤临床特征、治疗方式及短期预后的多中心研究. 中华神经外科杂志, 2021, 37: 331- 336.
6	Chen T , Xiong W , Zhao Z , Shan Y , Li X , Guo L , Xiang L , Chu D , Fan H , Li Y , Zou J . Development and external validation of a dynamic nomogram with potential for risk assessment of ruptured multiple intracranial aneurysms. Front Neurol, 2022, 13: 797709. doi: 10.3389/fneur.2022.797709
7	Xiao ZP , Cui YD , Pan YH , Wan JQ , Zhang XH , Zhao B . Clinical effect analysis of endovascular embolization for the intracranial microaneurysm: a single-center prospective study. Zhongguo Nao Xue Guan Bing Za Zhi, 2021, 18: 25- 29. URL
	肖志朋, 崔雨迪, 潘耀华, 万杰清, 张晓华, 赵兵. 血管内栓塞颅内微小动脉瘤的临床疗效分析: 单中心前瞻性研究. 中国脑血管病杂志, 2021, 18: 25- 29. URL
8	Xie F , Huang L , Ye Y , Hao J , Lv J , Richard SA . Hybrid operation for arteriovenous malformations with associated multiple intracranial aneurysms and subarachnoid hemorrhage: case report. Medicine (Baltimore), 2022, 101: e28944. doi: 10.1097/MD.0000000000028944
9	Ling GY , Mo LG , Lin X , Yan J , Lei Y , Liu H . Analysis of the therapeutic effect of LVIS stent on multiple intracranial aneurysms assisted by primary embolization. Lin Chuang Fang She Xue Za Zhi, 2020, 39: 2083- 2087. URL
	凌国源, 莫立根, 林雄, 严峻, 雷奕, 刘红. LVIS支架一期辅助栓塞颅内多发动脉瘤的疗效分析. 临床放射学杂志, 2020, 39: 2083- 2087. URL
10	Li CW , Wang F , Yi ZQ , Zhang Y , Duan HZ , Li L , Zhang JY . Evaluation of the single stage treatment of intracranial or extracranial artery stenosis combined with intracranial aneurysm: experience from a single center. Zhonghua Wai Ke Za Zhi, 2021, 59: 210- 215.
	李春伟, 王峰, 伊志强, 张扬, 段鸿洲, 李良, 张家湧. 颅内外动脉狭窄合并颅内动脉瘤同期血管内治疗的效果分析. 中华外科杂志, 2021, 59: 210- 215.
11	Dinger TF , Darkwah Oppong M , Park C , Said M , Chihi M , Rauschenbach L , Gembruch O , Deuschl C , Wrede KH , Lenz V , Kleinschnitz C , Forsting M , Sure U , Jabbarli R . Development of multiple intracranial aneurysms: beyond the common risk factors. J Neurosurg, 2022, 137: 1056- 1063. doi: 10.3171/2021.11.JNS212325
12	Zhang Q , Hou Y , Wang Q , Chen X . Intracranial arteriovenous malformation combined with multiple aneurysms diagnosed by cta: a case report. J Belg Soc Radiol, 2023, 107: 16. doi: 10.5334/jbsr.3006
13	Sakuma M , Inagaki T , Arakawa R , Kato N , Okafuji T . Hereditary hemorrhagic telangiectasia presenting with asymptomatic liver lesions and a history of early-onset myocardial infarction and multiple intracranial aneurysms. Intern Med, 2023, 62: 553- 557. doi: 10.2169/internalmedicine.9259-22
14	Zhang XH , Zhao XY , Liu LL , Wen L , Wang GX . Identification of ruptured intracranial aneurysms using the aneurysm-specific prediction score in patients with multiple aneurysms with subarachnoid hemorrhages: a Chinese population based external validation study. BMC Neurol, 2022, 22: 201. doi: 10.1186/s12883-022-02727-w
15	Sharma MR , Kafle P , Rajbhandari B , Pradhanang AB , Kumar SD , Sedain G . Clinical characteristics and outcome of patients with multiple intracranial aneurysms from a university hospital in Nepal. Asian J Neurosurg, 2022, 17: 268- 273. doi: 10.1055/s-0042-1750822

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