Aneurysm recurrence associated with induced hypertension and hypervolemia

Area of Science:

• Neurosurgery
• Vascular Neurology
• Interventional Neuroradiology

Background:

• Cerebral vasospasm is a common complication after subarachnoid hemorrhage.
• Induced hypertension and hypervolemia (H&H) therapy is the standard treatment for neurological deficits secondary to vasospasm.
• The potential complication of aneurysm enlargement during H&H therapy has been theorized but not previously documented.

Observation:

• A patient with a previously clipped large distal basilar artery aneurysm developed cerebral vasospasm.
• The patient underwent prolonged H&H therapy to manage the vasospasm.
• Angiographic follow-up revealed recurrence and enlargement of the basilar artery aneurysm.

Findings:

• This case provides the first direct evidence of aneurysm enlargement as a complication of H&H therapy for vasospasm.
• The mechanism likely involves increased transmural pressure and stress on the aneurysm wall during induced hypertension.

Implications:

• Clinicians should consider the risk of aneurysm enlargement when utilizing H&H therapy in patients with pre-existing aneurysms.
• Further research is needed to elucidate the precise mechanisms and to develop strategies for mitigating this risk.
• This finding may influence treatment decisions and monitoring protocols for patients with aneurysms and vasospasm.