Endovascular treatment of cerebral aneurysm after renal transplantation in polycystic kidney disease

Abstract

Background Patients with polycystic kidney disease have a higher prevalence of intracranial aneurysms and may progress to renal failure requiring transplantation. The endovascular treatment of intracranial aneurysms may improve prognosis, since rupture often causes premature death or disability, but the nephrotoxicity risk associated with contrast medium must be always considered in cases of renal impairment. Methods A 55-year-old female patient with polycystic kidney disease and grafted kidney associated with anterior communicant artery aneurysm was successfully treated by embolization. Results The renal function remained normal after the procedure. To the authors' knowledge, this is the first case of endovascular treatment of brain aneurysm in a transplanted patient reported in the medical literature. Conclusions The endovascular procedure in renal transplant patients is feasible and can be considered to treat this population. Further studies and cases are needed to confirm its safety.

Keywords: Kidney transplantation; endovascular procedures; intracranial aneurysm; polycystic kidney disease.

Figure 1.

Magnetic resonance angiography is the initial screening test to diagnose aneurysm in patients with polycystic kidney disease; in this case it showed a saccular aneurysm (arrow) filling by the left anterior cerebral artery (small arrows).

Figure 2.

Angiogram showing (a) saccular aneurysm (arrow) in the anterior communicant complex; (b) it was embolized with coils (arrow) and remodeling balloon (small arrows); (c) a transprocedural rupture occurred (arrows) being controlled through balloon insufflation, protamine reversal of heparin, and coiling; (d) achieving aneurysm occlusion.