Gallo-Pineda Félix, Fernández-Gómez Miriam, Hidalgo-Barranco Carlos
J Neurosurg Case Lessons. 2023 Jun 26;5(26). doi: 10.3171/CASE23171.
Endovascular embolization of wide-necked aneurysms can be challenging. The development of intrasaccular devices like the Contour has enabled us to approach these aneurysms effectively by reducing recanalization rates and eliminating the need for dual antiplatelet therapy, which is particularly beneficial in the case of ruptured aneurysms. Although complications from using these devices are rare, it is crucial to address them properly. In this case, the authors highlight how to manage artery thrombosis caused by device protrusion during aneurysm embolization.
This report describes a complication in a male patient with a ruptured anterior communicating artery wide-necked aneurysm. Following Contour-assisted coiling of the aneurysm, a realignment of the detachable apex of the device occluded the A2 segment of the right anterior cerebral artery. After the failure of intra-arterial and intravenous tirofiban infusion as well as mechanical thrombectomy, a self-expanding open-cell stent was deployed in the involved vessel, achieving successful reperfusion.
The Contour device has a detachable zone that can cause occlusion of the parent vessel after deployment. The use of a stent as a rescue maneuver may be useful if reperfusion of the vessel cannot be achieved through other methods such as aspiration or full-dose antiplatelet therapy.
宽颈动脉瘤的血管内栓塞治疗具有挑战性。像Contour这样的瘤内装置的发展使我们能够通过降低再通率并消除双重抗血小板治疗的需求来有效治疗这些动脉瘤，这在破裂动脉瘤的情况下尤其有益。尽管使用这些装置引起的并发症很少见，但正确处理它们至关重要。在本病例中，作者强调了在动脉瘤栓塞过程中如何处理由装置突出引起的动脉血栓形成。
本报告描述了一名患有破裂的前交通动脉宽颈动脉瘤的男性患者的并发症。在Contour辅助下对动脉瘤进行弹簧圈栓塞后，装置可分离的顶端重新定位，闭塞了右侧大脑前动脉的A2段。在动脉内和静脉内输注替罗非班以及机械取栓失败后，在受累血管中植入了自膨式开孔支架，实现了成功再灌注。
Contour装置有一个可分离区域，在展开后可能导致载瘤血管闭塞。如果无法通过抽吸或全剂量抗血小板治疗等其他方法实现血管再灌注，使用支架作为挽救措施可能会有用。
