EMBOLIZATION OF ANEURYSM OF THE LEFT PMA IN THE ACUTE PERIOD OF INTRACRANIAL HEMORRHAGE IN A PATIENT WITH THE SEVERITY OF THE HUNT-HESS IV CONDITION

Abstract

Introduction. Treatment of cerebral aneurysms in the acute period of hemorrhage is a complex problem and is aimed at preventing repeated hemorrhage, which often leads to death, and in surviving patients to disability (40–50% and 70–75%, respectively). Currently, there are two methods of turning off cerebral aneurysms from the bloodstream: aneurysm clipping and embolization of the aneurysm cavity with microspirals in order to close the defect of the aneurysm wall due to rupture and filling its volume in order to form a blood clot. Taking into account the minimally invasive endovascular method of treatment, the possibility of balloon and chemoplasty in the case of vasospasm, it is increasingly used in patients in serious condition in the acute period of hemorrhage as the first stage or part of the combined surgical treatment of aneurysmal brain disease. The aim is to demonstrate the effectiveness of endovascular treatment of cerebral vascular aneurysms as the first stage in the acute period of hemorrhage in a patient with severe Hunt–Hess IV condition. Materials and methods. The patient, 51 years old, was taken to the St. Petersburg State Budgetary Healthcare Institution Mariinsky Hospital on emergency indications from the workplace in serious condition Hunt-Hess IV, tetraparesis to the point of plegia in the left extremities, unstable hemodynamics, symptoms of pulmonary edema. As a result of the examination (spiral computed tomography (SCT), SCT angiography, digital subtraction angiography), a massive Fisher IV ventriculo-subarachnoid hemorrhage and a saccular aneurysm of the A2 segment of the left anterior cerebral artery (LACA) were diagnosed. She was hospitalized in the intensive care unit (ICU). In the acute period of hemorrhage, embolization of the aneurysm was performed using Raymond II radicalization. The patient was on mechanical ventilation and then on respiratory support for 21 days. The postoperative period was complicated by takotsubo syndrome, deep vein thrombosis of both legs, and bilateral pneumonia. Results. 43 days after hospitalization, the patient was discharged for outpatient treatment with positive dynamics — with tetraparesis in the regression stage and clear consciousness.