Journal of Cerebrovascular and Endovascular Neurosurgery

  • 제25권4호
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  • Pages.434-439
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  • 2023
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  • 2234-8565(pISSN)
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  • 2287-3139(eISSN)
대한뇌혈관외과학회 (Korean Society of Cerebravascular Surgeons)
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Flow diversion of a middle cerebral artery pseudoaneurysm secondary to a gunshot wound: A case report

  • Justin C. Gelman (Harvard Medical School) ;
  • Max Shutran (Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School) ;
  • Michael Young (Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School) ;
  • Philipp Taussky (Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School) ;
  • Rafael A. Vega (Harvard Medical School) ;
  • Rocco Armonda (Department of Neurosurgery, MedStar Washington Hospital Center) ;
  • Christopher S. Ogilvy (Harvard Medical School)
  • 투고 : 2022.10.29
  • 심사 : 2023.04.14
  • 발행 : 2023.12.31
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초록

Pseudoaneurysms are rare but devastating complications of penetrating head traumas. They require rapid surgical or endovascular intervention due to their high risk of rupture; however, complex presentations may limit treatment options. Our objective is to report a case of severe vasospasm, flow diversion, and in-stent stenosis complicating the treatment of a middle cerebral artery pseudoaneurysm following a gunshot wound. A 33-year-old woman presented with multiple calvarial and bullet fragments within the right frontotemporal lobes and a large right frontotemporal intraparenchymal hemorrhage with significant cerebral edema. She underwent an emergent right hemicraniectomy for decompression, removal of bullet fragments, and evacuation of hemorrhage. Once stable enough for diagnostic cerebral angiography, she was found to have an M1 pseudoaneurysm with severe vasospasm that precluded endovascular treatment until the vasospasm resolved. The pseudoaneurysm was treated with flow diversion and in-stent stenosis was found at 4-month follow-up angiography that resolved by 8 months post-embolization. We report the successful flow diversion of an middle cerebral artery (MCA) pseudoaneurysm complicated by severe vasospasm and later in-stent stenosis. The presence of asymptomatic stenosis is believed to be reversible intimal hyperplasia and a normal aspect of endothelial healing. We suggest careful observation and dual-antiplatelet therapy as a justified approach.

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참고문헌

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