Aneurysm strategy

1. Vipul Gupta
Neurointerventional Surgery
(Interventional
Neuroradiology)
Institute of Neurosciences
Medanta the Medicity
Aneurysm Strategy – management beyond ego

2. Large – giant aneurysms ISUIA Trial

3. Flow diverters (stents)-

6. Giant
fusiform, no
collateral,
mass effect

7. Thrombosed after a week
Decompression
Independent, mild UL weakness

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)
 Fusiform giant ICA with no
collaterals– need bypass

9. Fusiform dissecting aneurysm…

14. 56 yr old,
ischaemic
stroke

16. 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..

17. Small Blister/dissecting
Friable, continued growth, re-rupture

18. F
A

19. Very small berry
aneurysms

21.  Near the neck rupture

22. Catheter reposition

23. 1-mm
coil

24. A B C
DYSPLASTIC BIFURCATION ANEURYSMS

25. • 64 year old lady
• History of blurring of
vision
• Left temporal
hemianopia

26. Most probably partially thrombosed
Will need stent…. Will recur

27. Dysplastic bifurcation aneurysms
- Needing complicated stenting
- Partially thrombosed

30. Branch from aneurysm- balloon overinflation

31. A B

35. Hemtoma –
not conscious
Hematoma ….
M6

36. Dysplastic aneurysm- high chance of recurrence

38. Progressive intraaneurysmal partial thrombosis starts
8th DAY POST COILING
10th DAY POST
COILING , sudden
clinical deterioration

39. Referred for surgery
 Giant fusiform needing bypass
 Dysplastic bifurcation needing
stenting/angulated vessels
 Distal dissecting, partially
thrombosed aneurysm
 Aneurysm with symptomatic
hematoma
 Mass effect
 Cost/follow-up/re-treatment
issues

43. For more information on
Stroke & Neurovascular Interventions
URL
www.sanif.co.in
Contact Us
https://www.facebook.com/vipul.gupta.35175
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44. THANK YOU