Open AccessAwake endovascular coiling of a dissected intracranial aneurysm in a third-trimester twin pregnancy
Author(s) -
Fei Xie,
Jianqiang Hao,
Seidu A. Richard,
Yanlin Yang,
Wuchun Zou,
Hong Bin Liu,
Min Deng,
Changwei Zhang
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000024239
Subject(s) - medicine , endovascular coiling , pregnancy , twin pregnancy , obstetrics , aneurysm , first trimester , third trimester , surgery , endovascular treatment , gestation , biology , genetics
Rationale: Subarachnoid hemorrhages (SAHs) from ruptured intracranial aneurysms are very rare during pregnancy. Management of ruptured intracranial aneurysms with SAH in pregnancy is often challenging because of the risks to the fetus and the mother. We present the first successful awake endovascular coiling of a dissected intracranial aneurysm in a third trimester twin pregnancy. Patient concerns: A 28 years’ old pregnant woman was admitted at the obstetric department of our hospital on account of very severe headaches associated with nausea and vomiting. Diagnosis: Emergency obstetric ultrasound scan done confirmed 32 weeks’ twin gestation, whereas magnetic resonance imaging established hemorrhage in the suprasellar cistern and the subarachnoid space. Magnetic resonance angiography revealed a dissected aneurysm in the ophthalmic segment of the left internal carotid artery. Interventions: Awake cerebral angiography as well as embolization of the aneurysm with coils was done via the transarterial route and the twins were delivered via caesarean section at 37 weeks’ gestation. Outcomes: Two years’ follow-up indicated no complications and children as well as their mother are healthy. Lesions: Awake endovascular coiling was very beneficial in our case because we avoided general anesthesia and the use of osmotic diuretics which are potentially hazardous during pregnancy.