Case presentation A 50 -year-old man came to the emergency department referring acute onset headache. Emergency brain CT scan showed diffuse bilateral subarachnoid hemorrhage in the Silvian scissure and in the peri-mesencephalic cistern.
CT angiography exam was performed, which showed a “blister-like’ aneurysm of the left vertebral artery (V4) (figure 1 A-B), near to the origin of the left PICA.
Due to the aneurysm morphology, a flow-diverter stent (Fred X 5x36 mm, Microvention) was positioned to treat the aneurysm, administering Cangrelor EV.
CT scan performed 1 month after the procedure showed complete resolution of the aneurysm, with patency of the posterior circulation.
CT angiography exam showed a “blister-like’ aneurysm of the left vertebral artery (V4) (figure 1 A-B), near to the origin of the left PICA, confirmed by VR reconstruction (C) and DSA (D).
(E) VR and MIP reconstructions of CT angiography performed 1 week and (F-G) 1 month after the procedure, showing patency of the posterior circulation, with no signs of reperfusion of the cerebral aneurysm at one month.
Discussion In this case the use of Cangrelor in an acute setting ensured to correctly treat a Patient who required acute flow-diverter stent placement for a ruptured aneurysm with complex morphology, not otherwise treatable.
This drug has a rapid ’onset’ and ’offset’, thanks to its short half-life, which could be useful in complex cases where high bleeding and thrombotic risks coexist.
Disclosure of Interest Nothing to disclose
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