Review
History
47 y/o male.
An intracranial aneurysm was occasionally detected by MR for one month.
Past medical history: No HTN or DM.
Medication: -
NE: (-)
47岁，男性。
头颅MR检查偶然发现颅内动脉瘤1月。
既往史：否认高血压、糖尿病。
药物：-
神经查体：-
Figure 1. MRI detected a suspicious intracranial aneurysm and no enhancement was observed.
图 1. MRI示可疑颅内动脉瘤，动脉瘤壁未见明显强化。
Figure 2 GIF. Compressed left ICA. Right ICA rotational angiogram confirmed an irregular anterior communicating artery aneurysm and the left A1 segment developed well.
图 2 GIF. 左侧颈内动脉压颈。右侧颈内动脉旋转造影证实前交通不规则动脉瘤，同时左侧大脑前A1段发育良好。
1
Strategy
An irregular small anterior communicating artery aneurysm with a high rupture risk should be treated.
Left A1 segment well developed, therefore the anterior communicating artery can be sacrificed if necessary.
Solitaire stent will be chosen to straighten the right anterior cerebral artery to reduce recurrence risk.
前交通动脉不规则小动脉瘤，破裂风险高，建议治疗。
左侧大脑前A1段发育良好，因此前交通动脉必要时可以闭塞。
为降低该动脉瘤复发风险，选择Solitaire支架于右侧大脑前动脉释放，拉直右侧大脑前动脉。
Figure 3 GIF. Measurements, An size 2.21*2.29mm, An neck 2.21mm. Right A1 segment proximal diameter 1.89mm, right A2 segment diameter 1.78mm. Headway-21 microcatheter was navigated into right A2 segment. 6F Envoy DA guiding catheter was placed at right ICA petrosal segment. Solitaire 4*20mm stent was deployed from right A2 to A1 segment.
图 3 GIF. 测量，动脉瘤大小2.21*2.29mm，动脉瘤颈2.21mm。右侧A1段近端直径1.89mm，右侧A2段直径1.78mm。Headway-21微导管置于右侧大脑前动脉A2段。6F Envoy DA导引导管置于右侧颈内动脉岩骨段。Solitaire 4*20mm于右侧A2至A1段释放。
Figure 4 GIF. No bleeding was observed. Then insert 2 coils (Hypersoft 2mm*4cm, Hypersoft 1.5mm*3cm).
图 4 GIF. 复查造影未见出血。然后填入2枚弹簧圈（ Hypersoft 2mm*4cm, Hypersoft 1.5mm*3cm ）。
Figure 5 GIF. The aneurysm was densely packed while a branch of right M3 segment occluded. General heparinization was performed and Tirofiban 14ml was administered.
图 5 GIF. 复查造影前交通动脉瘤致密栓塞，右侧大脑中动脉上干M3段分支闭塞。行全身肝素化，经导引导管给予替罗非班14ml。
Figure 6 GIF. Echelon-10 microcatheter was advanced into the occluded branch and Tirofiban 4ml in total was administered.
图 6 GIF. Echelon-10微导管超选至闭塞分支，经微导管分次给予替罗非班4ml。
Figure 7 GIF. Right ICA angiogram showed no relapse of the aneurysm and the occluded branch recanalize partially with pial arteries compensation.
图 7 GIF. 右侧颈内动脉造影显示动脉瘤致密栓塞，闭塞分支血管部分再通，远端软膜代偿良好。
Figure 8 GIF. The aneurysm was not visible and the left anterior cerebral artery was patent from left ICA angiogram.
图 8 GIF. 复查左侧颈内动脉造影动脉瘤未见显影，左侧大脑前动脉通畅。
Figure 9 GIF. Dyna-CT did not detect any hemorrhage.
图 9 GIF. 术后即刻Dyna-CT未见出血。
2
Post Operation
NE: GCS 15, no headache, eye movement normal, bilateral muscle strength normal, bilateral Babinski negative.
Medication:
Tirofiban 13ml/h maintained for 48 hours.
Aspirin 100mg for long term and Clopidogrel 75mg for 3 months.
查体：神经查体：GCS 15，无头痛，眼球各项运动正常，四肢肌力正常，双侧巴氏征阴性。
药物：
替罗非班13ml/h维持48小时。
阿司匹林100mg长期口服，氯吡格雷75mg口服3月停药。
Video 1. The aneurysm was densely embolized by 44 month follow up.
视频 1. 44月随访动脉瘤致密栓塞。
Figure 10. Solitaire straightened the parent artery.
图 10. Solitaire拉直成角。
Video 2. Right ICA angiogram showed intracranial arteries patent by 44 month follow up.
视频 2. 44月随访右侧颈内动脉造影示颅内血管通畅。
3
Summary
An irregular small anterior communicating artery aneurysm with a high rupture risk should be treated.
Left A1 segment well developed, therefore the anterior communicating artery can be sacrificed if necessary.
Long term follow up demonstrated that parent artery straightened by Solitaire stent was safe and effective.
The small irregular aneurysm with a low recurrence did not need dense packing. The key point of this kind of aneurysm was avoiding intra-operative aneurysm rupture.
前交通动脉不规则小动脉瘤，破裂风险高，建议治疗。
左侧大脑前A1段发育良好，因此前交通动脉必要时可以闭塞。
长期随访结果示Solitaire支架拉直载瘤动脉成角是安全有效的。
小的不规则动脉瘤栓塞后不易复发，不强调致密栓塞。预防术中操作导致动脉瘤破裂出血是主要问题。
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