Sugrel therapy groupDecade of life 4th 6th Gender F M Procedure Stent assisted coiling of basilar apex Anx PED remedy of appropriate ICA Anx PED remedy of left cavernous carotid artery Anx Coiling of left superior cerebellar artery Anx Balloon angioplasty and stenting of suitable ICA stenosis Balloon angioplasty and stenting of ideal ICA stenosis Preprocedural antiplatelet therapy ASA 325 mg PO day-to-day; prasugel 60 mg PO load ASA 325 mg PO every day; prasugrel 60 mg PO load ASA 325 mg PO everyday; prasugrel 60 mg PO load ASA 325 mg PO daily; prasugrel 60 mg PO load ASA 325 mg PO everyday; prasugrel 60 mg PO load ASA 325 mg PO every day; prasugrel 60 mg PO load Postprocedural antiplatelet therapy ASA 325 mg PO day-to-day; prasugrel ten mg PO every day ASA 325 mg PO everyday; prasugrel 10 mg PO everyday Prasugrel 10 mg PO everyday ASA 81 mg PO each day; clopidogrel 75 mg PO every day; prasugrel 10 mg PO PPD 1e2 ASA 325 mg PO daily; prasugrel 10 mg PO daily ASA 325 mg PO day-to-day; prasugrel 10 mg PO day-to-day Complications Basilar artery perforation, SAH, IVH, hydrocephalus Suitable cervical ICA perforation with neck hematoma; spontaneous flank, groin and scrotal hematomas Left frontal IPH; upper GI bleed requiring blood transfusion Right cerebellar IPH38th 6thF F55th 6thM MEpistaxis requiring nasal packing Epistaxis requiring nasal packing and blood transfusionAnx, aneurysm; ASA, acetylsalicylic acid (aspirin); ICA, internal carotid artery; IPH, intraparenchymal hemorrhage; IVH, intraventricular hemorrhage; PED, pipeline embolization device; PO, orally; PPD, postprocedure day; SAH, subarachnoid hemorrhage.J NeuroIntervent Surg 2013;5:33743. doi:10.1136/neurintsurg2012Clinical neurologyFigure 1 (A) Anteroposterior view of the cerebral vasculature following a left vertebral artery contrast injection. A large aneurysm in the basilar apex is visualized. (B) Active extravasation of contrast agent from the lateral wall of your basilar artery (denoted by arrowhead). (C) Repeat cerebral catheter angiogram with injection of the left vertebral artery displaying near complete aneurysm occlusion after endovascular coil embolization. (DeF) Serial sections from a noncontrast head CT displaying diffuse hyperdensity inside the basilar cisterns, bilateral Sylvian fissures and intraventricular space with obstructive hydrocephalus.5-Bromo-7-methoxy-1H-indazole site the internal carotid artery (figure 2D).Buy2252403-85-1 The patient remained intubated and was transferred for the intensive care unit.PMID:25804060 On PPD 2, he became hemodynamically unstable and was discovered to possess a sizable rectus sheath and ideal groin hematoma (figure 2E). He was taken for the operating room with vascular surgery for placement of a covered iliofemoral stent for hemorrhage handle. On PPD 3, he was restarted on full dose aspirin and prasugrel. The identical day, the patient was noted to be much less responsive, tachypneic and tachycardic. Chest CT demonstrated substantial bilateral pulmonary emboli. He was began on a bivalirudin intravenous drip. He was extubated on PPD 5. Coumadin therapy was began for deep venous thromboses and pulmonary emboli. He was discharged to a rehabilitation facility on PPD 15 and had a meaningful neurological recovery.Case NoA lady in her sixth decade of life having a ten year history of an asymptomatic left superior cerebellar artery aneurysm presented having a two month history of diplopia. Catheter angiography revealed a 12322 mm left superior cerebellar artery aneurysm (figure 4A). The patient was loaded with clopidogrel (300 mg orally) after which started on full dose aspirin and clopidogr.
