Endovascular treatment of acutely ruptured intracranial aneurysms in pregnancy

doi:10.1067/mob.2001.115861

American Journal of Obstetrics and Gynecology

Volume 185, Issue 5, November 2001, Pages 1261-1262

https://doi.org/10.1067/mob.2001.115861 Get rights and content

Abstract

Intracranial aneurysm rupture is responsible for important morbidity and mortality during pregnancy. We report 2 cases of subarachnoid hemorrhage in pregnant women resulting from ruptured aneurysms. Both patients were treated by endovascular approach. Successful maternal and fetal outcome were achieved in both cases without craniotomy and aneurysmal surgical exposure. (Am J Obstet Gynecol 2001;185:1261-2.)

Section snippets

Case 1

A 28-year-old woman was admitted at 32 weeks’ gestation with headache and vomiting. A computed tomography scan showed a subarachnoid hemorrhage. Magnetic resonance angiography examination revealed an arterial aneurysm. After cesarean delivery of a healthy infant, the patient immediately underwent cerebral angiography, which demonstrated a 4-mm aneurysm at the bifurcation of the right internal carotid artery. Then, the embolization procedure was performed with superselective catheterization of

Comment

The risk of rupture of previously unruptured aneurysms is reported to vary from 0.05% to 6% per year, depending mainly on aneurysm size and previous history of other aneurysm rupture. Intracranial hemorrhage during pregnancy, from an intracranial aneurysm or arteriovenous malformation, is a grave complication responsible for 5% to 12% of all maternal deaths. Irrespective of the cause, parity, or gestational age, intracranial hemorrhage occurs antepartum in 92% of patients and postpartum in 8%.

References (2)

MA Stoodley et al.
Pregnancy and intracranial aneurysms
Neurosurg Clin N Am
(1998)
C Cognard et al.
Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils
Radiology
(1999)

Cited by (70)

A Pregnant Woman with Cranial Aneurysm Rupture in the Second Trimester of Pregnancy
2020, World Neurosurgery
Citation Excerpt :
However, in some settings, simple coiling is not enough, and stenting may be necessary. Although there are insufficient clinical studies of dual antiplatelet treatment of pregnant patients available, stenting in aSAH is generally associated with increased mortality and morbidity.13 The need for anticoagulation following endovascular stenting is an important issue that needs to be taken into consideration regarding risk of rebleeding.6
Reports of cerebral aneurysm and aneurysm rupture during pregnancy are rare in the literature. Aneurysms might rupture and cause intracranial hemorrhage during or after pregnancy. Aneurysmal subarachnoid hemorrhage during pregnancy presents a challenge regarding treatment and management. No institution has reported a large patient population or experience in managing this condition during pregnancy in the literature. Owing to the limited number of cases, there are no available treatment guidelines, and treatment is usually based on a case-by-case approach.
A 31-year-old woman presented in the 27th week of pregnancy with sudden-onset headache, which was diagnosed as subarachnoid hemorrhage. The diagnosis of subarachnoid hemorrhage with an aneurysm located on the anterior communicating artery was made with magnetic resonance imaging and digital subtraction angiography. The aneurysm was treated by surgical clipping. The pregnancy continued successfully until the 35th gestational week, when the infant was successfully delivered by planned cesarean section owing to preeclampsia and fetal growth retardation. Postoperative follow-up was uneventful.
We present our experience in the management of aneurysmal subarachnoid hemorrhage during pregnancy and maternal and fetal outcomes of this rare disease. More cases and multicenter studies are needed to develop standardized management of this disease.
Spontaneous false aneurysm of the extracranial internal carotid artery - during pregnancy
2019, JMV-Journal de Medecine Vasculaire
Les faux anévrismes carotidiens extracrâniens sont rares, mais graves à cause du risque élevé de rupture et d’accidents vasculaires cérébraux ischémiques d’origine thromboembolique. Bien que les changements physiologiques hémodynamiques et hormonaux chez la femme enceinte puissent favoriser les ruptures artérielles et le développement de faux anévrismes, un seul cas de faux anévrisme carotidien extracrânien lié à la grossesse a été rapporté dans la littérature. La chirurgie reste le traitement de choix de ces lésions. Nous rapportons le cas d’un faux anévrisme spontané de l’artère carotide interne extracrânienne survenant en fin de grossesse. L’intervention chirurgicale a consisté en une mise à plat du faux anévrisme associée à une greffe prothétique avec bonne évolution.
Extracranial carotid false aneurysms are rare but serious because of the high risk of rupture and thromboembolic ischemic strokes. Although hemodynamic and hormonal physiological changes in pregnant women may favor arterial rupture and the development of false aneurysms, only one case of extracranial carotid false aneurysm related to pregnancy has been reported in the literature. Surgical repair is still the treatment of choice of these lesions. We report a case of spontaneous false aneurysm of the extracranial internal carotid artery occurring at the end of pregnancy. The surgical procedure consisted in resection of the false aneurysm with interposition of a prosthetic graft. The follow-up was uneventful.
Pregnancy
2017, Essentials of Neuroanesthesia
Pregnant patients present with significant physiological alterations that may pose challenges in their management during neurosurgery. While some disease processes predate pregnancy, such as epilepsy, multiple sclerosis, and benign intracranial lesions, there are other conditions that have an increased incidence during pregnancy, like hemorrhagic and vaso-occlusive strokes and symptomatic disk herniation. Trauma during pregnancy, including head injury, is a leading cause of incidental maternal death and morbidity. Services of a neuroanesthetist may be seeked for a pregnant patient for indications like intracranial tumor or abscess excision and spinal cord tumor or lesion removal and for diagnostic and therapeutic interventions. Direct involvement of the neuroanesthetist may also be required in neuroradiological interventions in subarachnoid hemorrhage (intracranial aneurysms, arteriovenous malformations) and stroke. Principles of management may be contradictory, and both maternal and fetal well-being need to be taken into consideration.
Aneurysmal Subarachnoid Hemorrhage in Pregnancy - Case Series, Review, and Pooled Data Analysis
2016, World Neurosurgery
Citation Excerpt :
Only in 3 cases did diagnosis and treatment avoid ionizing radiation entirely (magnetic resonance imaging [MRI] followed by magnetic resonance angiography [MRA] and aneurysm clipping). In 1 case,28 CS was performed after diagnostic MRA and DSA was acquired thereafter. Aneurysm occlusion was achieved by surgical clipping in 53.8% of the cases (n = 28) and with an endovascular procedure in 36.5% (n = 19).
Aneurysmal subarachnoid hemorrhage (aSAH) during pregnancy represents an important cause of maternal and fetal morbidity and mortality. Approaches to diagnostics and treatment are still controversial, and there are only a limited number of cases described in the literature. Our study examines the management of aSAH in pregnant patients, creating a case series by combining patients from our hospital records with those from the limited available literature.
Data collected from Addenbrooke's Hospital records and cases published between January 1995 and January 2015 were studied. Chi-square test, exact Fisher's test, and chi-square test for trend were used for analyzing categorical data, while the t-test and Mann-Whitney-Wilcoxon test were used for continuous data.
Fifty-two patients were included. The mean age was 31.47 ± 5.80, and most patients were in their third trimester. A univariate pooled data analysis suggested that the maternal outcome may depend on the mother's age, mother's Hunt and Hess scale score, Glasgow Coma Scale at arrival, treatment modality for the aneurysm, mode, and timing of delivery. However, at the multivariate analysis only the presence of general complications resulted in a significant impact on maternal outcome.
Ruptured aneurysms in pregnant patients with aSAH may be safely secured in a timely manner. The diagnostic and treatment strategy for each of these patients should consider peculiar maternal and obstetric factors and requires a multidisciplinary assessment involving obstetrics, neurosurgeons, and intensivists. Considering the observed statistical power of our series, our findings should be taken with caution and should be supported by further systematic data collection.
Neurologic Complications in Pregnancy
2016, Critical Care Clinics
Stroke Around Pregnancy; Protection and Prevention!
2023, Annals of Indian Academy of Neurology

View all citing articles on Scopus

^☆: Reprint requests: Jacques Moret, MD, Neuroradiologie Interventionnelle et Fonctionnelle, 25-29 rue Manin 75940 Paris Cedex 19, France. E-mail: [email protected]

View full text

Case ReportsEndovascular treatment of acutely ruptured intracranial aneurysms in pregnancy☆

Abstract

Section snippets

Case 1

Comment

Neurosurg Clin N Am

Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils

Radiology

Case Reports
Endovascular treatment of acutely ruptured intracranial aneurysms in pregnancy☆