Endovascular management of complex ruptured aneurysms: our experience

1. Endovascular management of
complex ruptured aneurysms:
our experience
Vipul Gupta
Neurointerventional Surgery
(Interventional Neuroradiology)
Institute of Neurosciences
Medanta the Medicity

2. “COMPLEX” ANEURYSMS
•Giant aneurysms
• Dissecting fusiform
•Blister aneurysms
•Aneurysms with near the neck rupture/lobules
•Dysplastic bifurcation aneurysms
•Aneurysm with artery from the sac
May be..
• Aneurysm with vasospasm
•Aneurysm with tortuosity
•Small aneurysms
•Multilobulated aneurysms
•Aneurysm with thrombus

3. 1917
pts.
451
patients
ISUIA Trial

5. Flow diverters (stents)-

8. 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)

11. 38 yr old male patient, 2-day old SAH
Known hypertensive
Clinically grade II
Small Blister/dissecting
Friable, continued growth,
re-rupture

13.  Follow up after 2 months

14. Classical blister aneurysm

16. F
A

17. 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

18. Very small berry
aneurysms

20.  Near the neck rupture

21. Catheter reposition

22. 1-mm
coil

23. A B C
DYSPLASTIC BIFURCATION ANEURYSMS

26. Branch from aneurysm- balloon overinflation

27. A B

31. Complex aneurysms…
 Important to recognize and analyze (3D)
 Comfortable with all approaches and
techniques
 Strategy with back-up plan
 Better outcomes in high volume centres
with expertise, technology (Biplane) and
teamwork
 Vascular Neurosurgery co-ordination

32. Thank you