Endovascular management of complex ruptured aneurysms:

our experience

Vipul GuptaNeurointerventional Surgery(Interventional Neuroradiology)Institute of Neurosciences Medanta the Medicity

“COMPLEX” ANEURYSMS•Giant aneurysms• Dissecting fusiform•Blister aneurysms•Aneurysms with near the neck rupture/lobules•Dysplastic bifurcation aneurysms •Aneurysm with artery from the sac

May be..• Aneurysm with vasospasm•Aneurysm with tortuosity •Small aneurysms•Multilobulated aneurysms •Aneurysm with thrombus

1917 pts.

451 patients

ISUIA Trial

Flow diverters (stents)-

Giant/large aneurysms

Stent-assisted coiling – safe, follow-up and possible repeat treatment

Flow diverters - evolving, paraclinoidal aneurysms, ?risk

(Parent vessel occlusion – may be the ideal treatment for cavernous aneurysms)

38 yr old male patient, 2-day old SAHKnown hypertensive

Clinically grade II

Small Blister/dissecting Friable, continued growth, re-rupture

Follow up after 2 months

Classical blister aneurysm

F

A

Fusiform-dissecting aneurysms & blister aneurysms

Extremely difficult to treat Overlapping stents with coils as much

as possible to buy time/promote thrombosis

Continued growth common- early check Flow diverter

Very small berry aneurysms

Near the neck rupture

Catheter reposition

1-mm coil

A B C

DYSPLASTIC BIFURCATION ANEURYSMS

Branch from aneurysm- balloon overinflation

A B

Complex aneurysms… Important to recognize and

analyze (3D) Comfortable with all approaches

and techniques Strategy with back-up plan Better outcomes in high volume

centres with expertise, technology (Biplane) and teamwork

Vascular Neurosurgery co-ordination

Thank you