Exclusion of the anterior communicating artery with endovascular flow diverters – A possible treatment method of a wide-necked aneurysm

Introduction: We describe a case of a patient with severe subarachnoid hemorrhage from the rupture of difficult-to-treat morphology, a suspected partially thrombosed anterior communicating artery aneurysm. Case presentation: The patient was admitted with World Federation of Neurosurgeons (WFNS) score of 4 and a Fisher grade IV hemorrhage. Angiography demonstrated a wide neck anterior communicating artery aneurysm not suitable for the standard coiling and surgical treatment. On the 10th day after the bleeding, endovascular treatment was performed to exclude the anterior communicating artery from the circulation by implanting flow diverters to A2 to A1 on both sides. On Day 18, a CT scan showed communicating hydrocephalus, and thus the patient was treated with a ventriculoperitoneal shunt. At the four-month follow-up, angiography showed O'Kelly-Marotta grade D aneurysm occlusion, and the patient's modified Rankin score was 0. The patient made a complete recovery. Discussion: Even though this was a rare application of the flow diverter, other treatment approaches, including detachable coil, stent implantation, and surgical clipping were considered less safe and less effective treatment in this case of anterior communicating artery aneurysm. Conclusion: Endovascular exclusion of the anterior communicating artery from the circulation may be a safe and effective treatment approach in cases without significant perforant artery branches where the conventional endovascular treatment is not considered to be applicable. © 2023 The Author

Exclusion of the anterior communicating artery with endovascular flow diverters – A possible treatment method of a wide-necked aneurysm

Introduction: We describe a case of a patient with severe subarachnoid hemorrhage from the rupture of difficult-to-treat morphology, a suspected partially thrombosed anterior communicating artery aneurysm. Case presentation: The patient was admitted with World Federation of Neurosurgeons (WFNS) score of 4 and a Fisher grade IV hemorrhage. Angiography demonstrated a wide neck anterior communicating artery aneurysm not suitable for the standard coiling and surgical treatment. On the 10th day after the bleeding, endovascular treatment was performed to exclude the anterior communicating artery from the circulation by implanting flow diverters to A2 to A1 on both sides. On Day 18, a CT11 Computed tomography. scan showed communicating hydrocephalus, and thus the patient was treated with a ventriculoperitoneal shunt. At the four-month follow-up, angiography showed O'Kelly-Marotta grade D aneurysm occlusion, and the patient’s modified Rankin score was 0. The patient made a complete recovery. Discussion: Even though this was a rare application of the flow diverter, other treatment approaches, including detachable coil, stent implantation, and surgical clipping were considered less safe and less effective treatment in this case of anterior communicating artery aneurysm. Conclusion: Endovascular exclusion of the anterior communicating artery from the circulation may be a safe and effective treatment approach in cases without significant perforant artery branches where the conventional endovascular treatment is not considered to be applicable

Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months

MRC CRASH is a randomised controlled trial (ISRCTN74459797) of the effect of corticosteroids on death and disability after head injury. We randomly allocated 10,008 adults with head injury and a Glasgow Coma Scale score of 14 or less, within 8 h of injury, to a 48-h infusion of corticosteroid (methylprednisolone) or placebo. Data at 6 months were obtained for 9673 (96.7%) patients. The risk of death was higher in the corticosteroid group than in the placebo group (1248 [25.7%] vs 1075 [22.3%] deaths; relative risk 1.15, 95% CI 1.07-1.24; p=0.0001), as was the risk of death or severe disability (1828 [38.1%] vs 1728 [36.3%] dead or severely disabled; 1.05, 0.99-1.10; p=0.079). There was no evidence that the effect of corticosteroids differed by injury severity or time since injury. These results lend support to our earlier conclusion that corticosteroids should not be used routinely in the treatment of head injury