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Case Reports
. 2018 Nov;97(48):e13320.
doi: 10.1097/MD.0000000000013320.

A case report on middle cerebral artery aneurysm treated by rapid ventricular pacing: A CARE compliant case report

Yi Ping  1 , Huahua Gu
Affiliations
Case Reports

A case report on middle cerebral artery aneurysm treated by rapid ventricular pacing: A CARE compliant case report

Yi Ping et al. Medicine (Baltimore). 2018 Nov.

Abstract

Rationale: Cerebral aneurysm is a common cause of intracranial hemorrhage, stroke, and death. It is treated with vascular surgeries, such as coil embolism and artery clipping. However, surgery itself is a risk factor that may cause rupture of aneurysm, and leads to irreversible brain damage, and even death. Rapid ventricular pacing (RVP) is a procedure that temporarily lowers blood pressure by increasing heart rate and reducing ventricular filling time. RVP has been widely used to reduce blood vessel tension in many cardiovascular surgeries.

Patient concerns: A 46-year-old man came to our hospital with intermittent right-side headache for 5 years, and left lower limb numbness for 3 months.

Diagnoses: Magnetic resonance imaging (MRI) of the head and digital subtraction angiography confirmed the diagnosis of right middle cerebral artery (MCA) aneurysm.

Interventions: Considering the large size of this MCA aneurysm, RVP was used to reduce blood pressure during MCA aneurysm repair, and to lower the risk of intracranial hemorrhage during procedure.

Outcomes: Post procedure, there was no abnormality detected. Seven weeks after surgery, the patient's muscle tone of right side extremities were grade V and left side extremities were grade IV. Computed tomography angiography confirmed no MCA aneurysm.

Lessons: In cases of aneurysm rupture, RVP will induce a transient "very low pressure" condition, and give a valuable time frame to clip the ruptured aneurysm. Therefore RVP is a safe and effective method to provide transient reduction of cardiac output in intracranial aneurysm patients.

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Figures

Figure 1
Figure 1
Head CT scan and MRI of patient before surgery. (A–B) Head CT scan. Right temporal area has a high-dense round lesion. The edge of lesion is sharp and no sign of edema. (C–D) Head MRI contrast-enhanced T1-weighted scan. The lesion has strong signal in contrast-enhanced T1-weighted MRI, suggesting it may be an aneurysm. (E–F) Head MRI T2-weighted. (G–H) Head MRI T1-weighted. MRI = magnetic resonance imaging.
Figure 2
Figure 2
Digital subtraction angiography (DSA) confirmed the MCA aneurysm. MCA = middle cerebral artery.
Figure 3
Figure 3
Record of vital sign monitoring during procedure. a, b, c, and d indicated four RVP during surgery. RVP = rapid ventricular pacing.
Figure 4
Figure 4
Computed tomography angiography confirmed the MCA aneurysm is clipped. MCA = middle cerebral artery.
See this image and copyright information in PMC

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References

    1. Zacharia BE, Bruce SS, Carpenter AM, et al. Variability in outcome after elective cerebral aneurysm repair in high-volume academic medical centers. Stroke 2014;45:1447–52. - PubMed
    1. Brinjikji W, Lanzino G, Kallmes DF, et al. Cerebral aneurysm treatment is beginning to shift to low volume centers. J Neurointerv Surg 2014;6:349–52. - PubMed
    1. Guglielmi G, Vinuela F, Sepetka I, et al. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: electrochemical basis, technique, and experimental results. J Neurosurg 1991;75:1–7. - PubMed
    1. Pierot L, Cognard C, Anxionnat R, et al. Ruptured intracranial aneurysms: factors affecting the rate and outcome of endovascular treatment complications in a series of 782 patients (CLARITY study). Radiology 2010;256:916–23. - PubMed
    1. Elijovich L, Higashida RT, Lawton MT, et al. Predictors and outcomes of intraprocedural rupture in patients treated for ruptured intracranial aneurysms: the CARAT study. Stroke 2008;39:1501–6. - PubMed

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