Complicated decision-making AcomA aneurysm

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Hi all!
I thought I’d have a decision and a date by now, but we are still struggling to find the right course of action. I met with the neurosurgeon again to schedule a summer surgery, but he is now consulting with his partners again regarding the best course of action for this complicated aneurysm.

The doc writes:
Given the wide neck, an endovascular solution would likely require a “Y” stenting construct and require dual anti-platelet therapy in the short-term and long-term aspirin therapy for life. It does have the added potential benefit of reconstructing and reinforcing the anterior communicating artery segment with the stent construct. That being said, it may be difficult to get a complete embolization of the aneurysm with coils and there may be a neck remnant.

Given the bilobed nature and circumferentially diseased nature of the anterior communicating artery I think that clipping will be difficult to get a perfect result and that some diseased anterior communicating artery will remain unprotected which can be reinforced with some Teflon.

After thorough discussion I suggested that I will show the films to my partners. I will also review the pictures at next vascular conference. I will touch base next week to discuss a treatment plan and schedule treatment.

I am open to either option but I told the doctor my particular concerns regarding the endovascular option were: 1) the anti-platelet therapy interferes with my use of anti-inflammatories for my psoriatic arthritis; 2) I have higher cardiovascular/stroke risk already with the psoriatic arthritis and I don’t know how I will react to the stents with my inflammatory condition. (I already have titanium plates and screws in my neck, so titanium clips shouldn’t be a problem).

Of course, I am also concerned about open brain surgery and only want to go that route if it can give me a definitive solution to the problem. I guess that’s what they are discussing – which can give the better result? – Is it better to clip diseased tissue into a functional artery complex or to leave a neck remnant and stents in a potentially better-flowing complex?

At this point, I am so tired of thinking about it. It’s been six months now of debating the pros and cons with myself, my husband, my family members, etc. Ultimately, I don’t think there is any way to know which will have the better outcome and I will do whatever the docs decide this week. I am so ready to have this done and at least I know it will happen this summer now!

Thank you for listening! Has anyone had the wrapping of a clipped aneurysm with Teflon? I can’t find a lot of recent articles on it. My understanding is that it’s been used for a long time for areas where clips can’t be used.

Cheers!
Jennifer

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Jennifer, I did a search and wrapping seems to have been done since at least the early 90’s with some pretty good results for most. It appears that the caution is for the Neurosurgeon to follow up for a good length of time, but I couldn’t find how long.

I think I shared with you that I have a multi lobed aneurysm, she quit counting at 24 daughter sacs. I’ve had two re-coilings, the last with balloon assist. She did a presentation on my aneurysm as she was already scheduled to discuss multilobed aneurysms at a conference. Having ruptured gave her some slides to show roflol.

I am very impressed your surgeon is not only talking to his partners but is willing to discuss it at a conference. I’m impressed, very impressed! I like a doctor who is sure of their ability, I love a doctor who knows they don’t know everything and are willing to learn. I’ve had several medical Neuro professionals who always want to second guess what my Doc has done for me. I tell them, she was willing to think outside the box and I’m still alive because of that, could you have guaranteed the same? It usually quiets them roflol. If I had to switch neuros, I’d want someone like yours!

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Moltroub, I really, really like my neurosurgeon. He is leaving my area in August so I feel really fortunate to have him do the surgery before he leaves. I’m pretty particular about doctors as I’ve had some bad experiences in the past and I am thankful that I haven’t been in an emergent situation.

I think I found the same info you did on the wrapping. He said I will require follow up regardless of which way they go with it. I’m definitely learning a lot more about aneurysms than I ever wanted to! lol

Thanks as always for your input.

Jennifer

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Hi,
I’m sorry for the difficult decision. 3 and a half years ago I had stents placed in a y-configuration along with 9 coils in my acom artery aneurysm. I take a daily low-dose aspirin and have never had any complications. I guess your main concern is the drug interactions. Fortunately I don’t need any other meds at this point. As far as the stents/coiling,I think they are a good option if you have a good Dr. Best of luck with whichever you end up choosing. It’s nice that your Dr. gives you so much detailed info.

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