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Unruptured Cerebral Aneurysms Presenting with Ischemic Events

Published online by Cambridge University Press:  02 December 2014

Nancy McLaughlin  and
Michel W. Bojanowski
Nancy McLaughlin
Affiliation:
Division of Neurosurgery, Department of Surgery, Centre hospitalier de l'Université de Montréal - Hôpital Notre-Dame, Montreal, QC, Canada
Michel W. Bojanowski*
Affiliation:
Division of Neurosurgery, Department of Surgery, Centre hospitalier de l'Université de Montréal - Hôpital Notre-Dame, Montreal, QC, Canada
*
Neurosurgery Division, CHUM-Hôpital Notre-Dame, 1560 Sherbrooke St. East, Montreal, Quebec, Canada, H2L 4M1.
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Abstract

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Background:

Patients harboring an unruptured cerebral aneurysm may present with ischemic events. The goal of this study is to assess the clinical and radiological characteristics and the outcome following treatment of these patients.

Methods:

The study population included 463 patients with unruptured cerebral aneurysms treated between January 2000 and November 2006. Patients with aneurysms manifesting with ischemic events were included. Outcome was assessed 12 months following aneurysm treatment using the modified Rankin scale.

Results:

Eleven patients were included in this series. An acute ischemic lesion in the symptomatic territory was demonstrated in six patients. The aneurysms were located on the internal carotid artery (n=4), middle cerebral artery (n=4), superior cerebellar artery (n=2) and basilar artery (n=1). They measured 10mm or less (n=7); 11-20mm (n=2); more than 21mm (n=2). Five aneurysms were partially thrombosed on imaging. Five patients were referred for coiling. Of these, one patient had an unsuccessful coiling attempt, one had a residual neck, and three presented an aneurysm recurrence. Six patients were treated surgically. Symptomatic thromboembolism occurred after surgery in three patients. Complete aneurysm exclusion was documented in five of six operated patients. Nine of the ten treated patients had a favorable outcome.

Conclusion:

Even though aneurysms presenting with ischemic events are often small and located on the anterior circulation, in this series the risk of thromboembolic events following aneurysm treatment is noteworthy. This information is relevant given the possible benign natural history in terms of stroke and risk of bleeding for some of these aneurysms.

Résumé:

RÉSUMÉ:Contexte:

Il arrive que des patients qui ont un anévrisme cérébral non rompu consultent pour un événement ischémique. Le but de cette étude était de décrire les caractéristiques cliniques et radiologiques de ces patients ainsi que le résultat de leur traitement. Méthodes : La population étudiée était constituée de 463 patients porteurs d'un anévrisme cérébral non rompu, traités entre janvier 2000 et novembre 2006. Les patients chez qui la manifestation de l'anévrisme était un événement ischémique ont été inclus dans l'étude. Le résultat était évalué 12 mois après le traitement de l'anévrisme au moyen de la Modified Rankin Scale. Résultats : Onze patients ont été inclus dans l'étude. Une lésion ischémique aiguë dans le territoire symptomatique a été démontrée chez six patients. L'anévrisme était localisé à la carotide interne (n = 4), à l'artère cérébrale moyenne (n = 4), à l'artère cérébelleuse supérieure (n = 2) et au tronc basilaire (n = 1). Il mesurait 10 mm ou moins (n = 7); 11-20 mm (n = 2) ; plus de 21 mm (n = 2). L'imagerie a démontré que cinq anévrismes étaient partiellement thrombosés. Cinq patients ont été dirigés en neuroradiologie pour un traitement endovasculaire. Ce traitement s'est soldé par un échec chez un patient, le col de l'anévrisme a persisté chez un patient et on a observé une récidive de l'anévrisme chez trois patients. Six patients ont subi une chirurgie. Trois patients ont présenté une thromboembolie symptomatique après la chirurgie. Une exclusion complète de l'anévrisme a été constatée chez cinq des six patients opérés. Neuf des dix patients traités ont eu une évolution favorable. Conclusion : Bien que les anévrismes cérébraux dont la première manifestation est un événement ischémique soient souvent de petite taille et localisés à la circulation antérieure, dans cette série de cas le risque d'événements thromboemboliques après le traitement de l'anévrisme n'est pas négligeable. Cette information est importante étant donné que certains de ces anévrismes ont une histoire naturelle qui peut être bénigne quant à l'accident vasculaire cérébral et au risque de saignement.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 5 , November 2008 , pp. 588 - 592
Copyright
Copyright © The Canadian Journal of Neurological 2008

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