2020 Volume 48 Issue 2 Pages 129-133
Purpose: Intracerebral hemorrhage (ICH) that develops after treatment of unruptured intracerebral aneurysms is a rare complication. We present one case of ICH after endovascular treatment and discuss the possible pathophysiologic mechanisms and preventative strategies.
Patient Case: A 51-year-old woman with left homonymous hemianopsia and a large paraclinoid (internal carotid-ophthalmic) aneurysm underwent flow diversion (FD) using the PipelineTM Embolization Device and coiling. Several hours postoperatively, she had motor aphasia with mild right hemiparesis, and head computed tomography revealed an ipsilateral frontotemporal hematoma. Magnetic resonance angiography and digital subtraction angiography suggested a form of hyperperfusion syndrome, and conservative management resulted in almost complete resolution of symptoms.
Conclusions: The etiology of ICH acutely following FD may be multifactorial due to dual antiplatelet therapy (DAPT) hyper-response and flow modification related to hyperperfusion and the Windkessel effect. Conservative management resulted in a good outcome. However, for severe hemorrhagic cases, platelet transfusion, discontinuation of DAPT to single antiplatelet therapy, and surgical intervention should be considered. Perioperative monitoring indicating antiplatelet hyper-response or radiographic hyperperfusion should direct strict blood pressure control and risk reduction precautions.
