Can thiệp điều trị phình động mạch não cổ rộng vị trí đỉnh thân nền bằng web: báo cáo ca lâm sàng

SUMMARY

A basilar tip artery bifurcation aneurysm was diagnosed incidentally in a 69-year-old female patient. She was a normal her medical history. The MRI revealed a non-ruptured aneurysm with a maximum fundus diameter 4.9mm. Selective cerebral angiography confirmed the presence of a wide-necked aneurysm with a mean transverse diameter of 5mm and a mean height of 3mm; the neck width was 4.9mm. With this complex anatomy, the multidisciplinary team recommended endovascular treatment of the aneurysm with the WEB device. The procedure was performed with dual antiplatelet therapy (75 mg aspirin PO daily 3 days and 180 mg ticagrelor PO daily 2 days prior to the intervention). Immediately after placement of the WEB device, DSA showed complete occlusion of the aneurysm but has thromboembolic event in P3 posterior cerebral artery and no deficit. Postoperatively the patient received dual antiplatelet therapy for 5 days and continued 75 mg aspirin PO for 2 weeks, ticagrelor was discontinued. The patient was discharged 2 days after the intervention without any neurological symptoms. Follow-up by MRI at 3, 6, by MRI and DSA 12 months after treatment confirmed the stable obliteration of the aneurysm without recurrence or reperfusion. The value of the WEB device in the endovascular treatment of wide-necked basilar tip artery bifurcation aneurysms is the main topic of this chapter.