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Endovascular coiling of a ruptured basilar apex aneurysm with associated pseudoaneurysm.

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      Abstract

      Acute intracranial pseudoaneurysms secondary to aneurysmal rupture are a rare entity with no clear evidence-based guidelines for treatment to our knowledge. There are numerous examples of successful treatment of pseudoaneurysms both surgically and endovascularly, the latter mainly within the anterior circulation. Risk of pseudoaneurysm rupture in the acute state during endovascular procedures with subsequent difficulty in controlling the bleeding without sacrificing the feeder artery has led to some reservation in using endovascular treatments more broadly. We report a rare case of a 52-year-old-woman who presented with acute subarachnoid hemorrhage and was found to have a ruptured 5 mm × 8 mm bi-lobulated basilar apex aneurysm on CT angiography. Digital subtraction angiography demonstrated an associated anterior pseudoaneurysm that was formed secondary to the aneurysm rupture. The true aneurysm was successfully coiled with careful avoidance of the pseudoaneurysmal sac. Pseudoaneurysms are frequently identified for the first time during digital subtraction angiography. Recognizing their presence is essential for treatment planning. Acute pseudoaneurysms associated with true aneurysmal rupture can be safely and successfully treated by endovascular coiling of the true aneurysm. Care must be taken to avoid manipulation of the pseudoaneurysmal sac during the embolization.

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      Affiliations
      [1 ] Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA.
      [2 ] Department of Neurosurgery, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA.
      [3 ] Department of Neurosurgery, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA.
      [4 ] Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, 55 Fruit Street, White Building Room 502, Boston, MA 02114, USA. Electronic address: walcott.brian@mgh.harvard.edu.
      [5 ] Department of Neurosurgery, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA.
      [6 ] Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA.
      Journal
      J Clin Neurosci
      Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
      Elsevier BV
      1532-2653
      0967-5868
      Sep 2014
      : 21
      : 9
      24768151 S0967-5868(14)00119-2 10.1016/j.jocn.2013.11.050

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