Treatment with flow diverter stent during pregnancy
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Treatment with flow diverter stent during pregnancy Raoul Pop 1,2 & Helene Cebula 3 & Aude Lambert 4 & Dan Mihoc 1 & Monica Manisor 1 & Cosmin Cindea 1 & Anca Hasiu 1 & Philippe Deruelle 5 & Salvatore Chibbaro 3 & Luc Mertz 6 & Francois Proust 3 & Remy Beaujeux 1,2 Received: 1 April 2020 / Accepted: 8 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Intracranial aneurysms are rarely diagnosed during pregnancy. If treatment is necessary, surgery was traditionally preferred over embolization in case of ongoing pregnancy, due to concerns regarding foetal radiation exposure. We present a case of 21 mm unruptured carotid-ophthalmic aneurysm diagnosed during pregnancy and treated with flow diversion. Foetal radiation dose was estimated between 1 and 5 mGy, well below recommended limits. Double antiplatelet therapy with prasugrel and aspirin was administered between week 17 and week 37, followed by uneventful vaginal delivery at 39 weeks. The new-born infant did not present any clinical abnormalities. Post-natal angiography showed complete aneurysm occlusion. To our knowledge, this is the first report of flow diverter stent placement during ongoing pregnancy. Although a good outcome was observed in this case, this result should be interpreted with caution. Further studies are needed in order to better define the safety profiles of intracranial stents and double antiplatelet therapies during pregnancy. Keywords Flow diverter . Stent . Aneurysm . Pregnancy
Introduction Intracranial aneurysms are rarely diagnosed during pregnancy. It remains controversial whether pregnancy, delivery and puerperium influence the risk of aneurysmal rupture. However, aneurysmal rupture during pregnancy does represent a non-negligible cause of non-obstetric maternal death and has been associated with significant foetal mortality.
* Raoul Pop [email protected] 1
Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France
2
Institut Hospitalo-Universitaire (iHU) Strasbourg, Strasbourg, France
3
Neurosurgery Department, Strasbourg University Hospitals, Strasbourg, France
4
Pharmacology Department, Strasbourg University Hospitals, Strasbourg, France
5
Obstetrics and Gynecology Department, Strasbourg University Hospitals, Strasbourg, France
6
Medical Physics Department, Strasbourg University Hospitals, Strasbourg, France
Due to concerns regarding foetal radiation exposure, surgery was traditionally preferred over embolization in case of ongoing pregnancy. More recently, there have been several case reports of endovascular treatments [1]. In almost all cases, the aneurysms were ruptured and treatment was performed with simple or balloon-assisted coiling. We present a case of large unruptured aneurysm diagnosed during pregnancy and treated with flow diversion.
Case description A 41-year-old female presented with nonspecific headache. A cerebral MRI revealed an unruptured 21.5 mm carotidophthalmic aneurysm. Following neurosurgical consultation, endovascular
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