Chiu Albert Ho Yuen, Ramesh Rajalakshmi, Wenderoth Jason, Davies Mark, Cheung Andrew
Department of Interventional Neuroradiology, Institute of Neurological Sciences, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia Prince of Wales Clinical School, University of New South Wales, Randwick, Australia.
Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia.
BMJ Case Rep. 2016 Sep 21;2016:bcr2016012657. doi: 10.1136/bcr-2016-012657.
Subarachnoid hemorrhage secondary to rupture of a circumferential dissecting aneurysm continues to be a treatment dilemma. Vessel sacrifice, when possible, continues to be the safest option but in certain cases this is not possible due to lack of collateral supply. In such cases, coil assisted endovascular flow diversion has become a potential option but the requirement for dual antiplatelet therapy in an unsecured intracranial aneurysm continues to raise concern.We present a 48-year-old man with a World Federation of Neurological Surgeons grade 5 subarachnoid hemorrhage, secondary to a ruptured intradural left vertebral artery dissecting aneurysm, who was treated successfully with a pipeline embolization device with Shield technology using aspirin and a single intravenous loading dose of abciximab. To our knowledge, this is the first case of an acute flow diversion performed using only aspirin as the sole oral antiplatelet agent.
继发于环形夹层动脉瘤破裂的蛛网膜下腔出血仍然是一个治疗难题。在可能的情况下，血管牺牲仍然是最安全的选择，但在某些情况下，由于缺乏侧支供应，这是不可能的。在这种情况下，弹簧圈辅助血管内血流导向已成为一种潜在的选择，但在未完全栓塞的颅内动脉瘤中使用双重抗血小板治疗的必要性仍然令人担忧。我们报告一名48岁男性，因左侧硬脊膜内椎动脉夹层动脉瘤破裂导致世界神经外科联合会5级蛛网膜下腔出血，使用带有Shield技术的Pipeline栓塞装置联合阿司匹林及单次静脉注射负荷剂量的阿昔单抗成功治疗。据我们所知，这是首例仅使用阿司匹林作为唯一口服抗血小板药物进行急性血流导向治疗的病例。
