Aneurysm Strategy – management beyond ego
-
Upload
dr-vipul-gupta -
Category
Health & Medicine
-
view
219 -
download
1
Transcript of Aneurysm Strategy – management beyond ego
Vipul GuptaNeurointerventional Surgery(Interventional Neuroradiology)Institute of Neurosciences Medanta the Medicity
Aneurysm Strategy – management beyond ego
Large – giant aneurysms ISUIA Trial
Flow diverters (stents)-
Giant fusiform, no collateral, mass effect
Thrombosed after a week Decompression Independent, mild UL weakness
Giant/large aneurysms Stent-assisted coiling – safe,
follow-up and possible repeat treatment
Flow diverters - evolving, paraclinoidal aneurysms, ?risk
(Parent vessel occlusion – may be the ideal treatment for cavernous aneurysms)
Fusiform giant ICA with no collaterals– need bypass
Fusiform dissecting aneurysm…
56 yr old, ischaemic stroke
Fusiform-dissecting aneurysms & blister aneurysms
Extremely difficult to treat Overlapping stents with coils as much
as possible to buy time/promote thrombosis
Continued growth common- early check Flow diverter
However , Distal fusiform dissecting
aneurysms.. Stent/FD not possible ---
bypass/surgical reconstruction..
Small Blister/dissecting Friable, continued growth, re-rupture
F
A
Very small berry aneurysms
Near the neck rupture
Catheter reposition
1-mm coil
A B C
DYSPLASTIC BIFURCATION ANEURYSMS
• 64 year old lady• History of blurring of
vision• Left temporal
hemianopia
Most probably partially thrombosed Will need stent…. Will recur
Dysplastic bifurcation aneurysms- Needing complicated stenting- Partially thrombosed
Branch from aneurysm- balloon overinflation
A B
Hemtoma – not conscious
Hematoma ….M6
Dysplastic aneurysm- high chance of recurrence
Progressive intraaneurysmal partial thrombosis starts
8th DAY POST COILING
10th DAY POST COILING , sudden clinical deterioration
Referred for surgeryGiant fusiform needing bypass Dysplastic bifurcation needing
stenting/angulated vesselsDistal dissecting, partially
thrombosed aneurysmAneurysm with symptomatic
hematomaMass effect Cost/follow-up/re-treatment
issues
For more information onStroke & Neurovascular Interventions
URLwww.sanif.co.in
Contact Us
https://www.facebook.com/vipul.gupta.35175https://www.facebook.com/snifstrokeawareness
https://www.youtube.com/channel/UCPOduml-5isFmkY-1nBN9Sg
THANK YOU