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Case report
Salvage of distal non-target coil embolization with stent placement and intravenous eptifibatide in a ruptured, unsecured, atypical aneurysm
  1. Nazli Janjua1,
  2. Sebina Bulic2,
  3. Benedict C Tan2,
  4. Kessarin Panichpisal3,
  5. John Miller4
  1. 1Asia Pacific Comprehensive Stroke Institute, Claremont, California, USA
  2. 2Department of Neurology, SUNY Downstate Medical Center, Brooklyn, New York, USA
  3. 3Department of Neurology, Bumrungrad International Hospital, Bangkok, Thailand
  4. 4Department of Neurosurgery, SUNY Downstate Medical Center, Brooklyn, New York, USA
  1. Correspondence to Dr N Janjua, Asia Pacific Comprehensive Stroke Institute, Claremont, California, USA; nazli.janjua{at}apcsi.org

Abstract

Introduction Small aneurysms may be challenging to embolize. In cases of subarachnoid hemorrhage (SAH) where treatment is delayed, physicians may have to balance the risks of certain required therapies (antiplatelet agents) with the risk of rerupture. We describe a case of a technically challenging anterior cerebral artery aneurysm requiring eptifibatide infusion prior to definitive aneurysm treatment.

Case report A 57-year-old woman with SAH, underwent coil embolization of a small fenestrated A1–A2 junction aneurysm. The procedure was complicated by downstream coil migration which was then treated with Enterprise stent placement in the pericallosal artery. This required subsequent infusion of a glycoprotein IIb/IIIa inhibitor until the aneurysm could be repaired surgically.

Conclusions Revascularization with a stent in a distal cerebral vessel may salvage inadvertent coil migration. Although it is undesirable to administer antiplatelet agents to patients with SAH, in these circumstances short acting agents may be used.

  • Aneurysm
  • Subarachnoid
  • Stent
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