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All Journal Journal of Neurointervention and Stroke (JNeViS)
Muh. Wildan Yahya
Department of Neurology, Kabupaten Kediri General Hospital, Kediri
Medicine & Pharmacology Neuroscience

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Two Strikes in the Cath Lab: Lessons from Repeat Aneurysm Ruptures During Endovascular Treatment Vita Kusuma Rahmawati; Achmad Firdaus Sani; Dedy Kurniawan; Faishol Hamdani; Muh. Wildan Yahya
Journal of Neurointervention and Stroke Vol. 2 No. 1: MAY 2026
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2026.21.19

Abstract

Highlight: Repeat aneurysm rupture during endovascular therapy is rare but often fatal This case highlights the need for careful hydrocephalus management and monitoring Dynamic neurological assessment guides urgent aneurysm repair and improves outcomes ABSTRACT Introduction: Repeat aneurysmal rupture in the catheterization laboratory remains a critical concern, with periprocedural mortality rates reported as high as 63%. Such rebleeding requires rapid multidisciplinary decision-making, particularly in high-grade aneurysmal subarachnoid hemorrhage (aSAH) complicated by hydrocephalus. Case: A 56-year-old hypertensive man presented with sudden-onset headache followed by loss of consciousness (Hunt and Hess grade III). Computed tomography (CT) revealed subarachnoid and intraventricular hemorrhage, and CT angiography identified a left saccular posterior communicating artery aneurysm. During induction in the catheterization laboratory, he developed severe headache, seizures, hypertension, and pupil anisocoria, raising concern for impending cerebral herniation. Owing to a postictal comatose state, his clinical Hunt and Hess grade deteriorated to grade V. Emergent CT confirmed acute hydrocephalus and rebleeding. Endovascular coiling was deferred, and an external ventricular drain was placed, resulting in improved consciousness. Subsequent angiography demonstrated contrast extravasation from the aneurysm dome, confirming rebleeding. The aneurysm ruptured three times over two weeks, including twice during separate catheterization laboratory sessions. Definitive endovascular coiling ultimately achieved near-complete aneurysm packing. Neurological status improved to Hunt and Hess grade II, followed by ventriculoperitoneal shunt placement. At discharge, the modified Rankin Scale score improved from 4 to 3 without new focal neurological deficits. Three-month follow-up confirmed stable neurological recovery. Conclusion: This case highlights the challenges of repeated aSAH rupture in the catheterization laboratory, emphasizing hydrocephalus management and dynamic Hunt and Hess grading to guide aneurysm treatment timing. Urgent endovascular coiling may be warranted despite clinical instability, using individualized strategies to optimize neurological outcomes.
The Impact of Elevated Mean Arterial Pressure on Mortality in Spontaneous Subarachnoid Hemorrhage Achmad Firdaus Sani; Taurus Laisari; Muh. Wildan Yahya; Vita Kusuma Rahmawati; Faishol Hamdani; Dedy Kurniawan; Sita Setyowatie
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.2

Abstract

Highlight: Elevated MAP is associated with increased in-hospital mortality in SAH patients High MAP increases the risk of rebleeding, cerebral edema, and vasospasm MAP, age, infection, and hydrocephalus are independent predictors of mortality ABSTRACT Introduction: Subarachnoid hemorrhage (SAH) remains a critical neurological emergency with high mortality and morbidity. Mean arterial pressure (MAP) plays an importance role in cerebral perfusion and hemodynamic stability in SAH patients. However, excessive MAP elevation potentially worsening clinical outcomes. This study investigates the impact of elevated MAP on in-hospital mortality among SAH patients. Objective: This study investigates the impact of elevated MAP on in-hospital mortality among SAH patients.  Method: A retrospective cross-sectional study was conducted using medical records of SAH patients admitted to Dr. Soetomo Academic Medical Center Hospital from 2013 to 2021. A total of 360 patients met the inclusion criteria. MAP was calculated upon admission and categorized as ≥125 mmHg or <125 mmHg. The primary outcome was in-hospital mortality. Logistic regression analysis was performed to assess the association between MAP and mortality while adjusting for confounders. Result: Among 360 SAH patients, 44.8% did not survive hospitalization. The mean age was 54 years, with an initial mean MAP of 117.45±21.6 mmHg. Bivariate analysis showed that MAP ≥125 mmHg significantly increased mortality risk (OR = 1.93; 95% CI: 1.24–2.98; p = 0.002). Multivariate logistic regression identified MAP ≥125 mmHg as an independent predictor of mortality (Adjusted OR = 1.795; p = 0.012), alongside age (Adjusted OR = 2.043; p = 0.004), infection (Adjusted OR = 2.442; p = 0.001), and hydrocephalus (Adjusted OR = 2.174; p = 0.003). Conclusion: Elevated MAP (≥125 mmHg) is significantly associated with increased in-hospital mortality in SAH patients. These findings highlight the importance of early hemodynamic management in SAH to improve patient survival.
Deferring Angioplasty and Stenting based on Natural Progression in Severe Middle Cerebral Artery Stenosis: An Observation of Two Cases Vita Kusuma Rahmawati; Achmad Firdaus Sani; Dedy Kurniawan; Muh. Wildan Yahya; Faishol Hamdani
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.5

Abstract

Highlight: MCA stenosis may remodel spontaneously or progress to complete occlusion Serial imaging observing progression spots high-risk cases, guiding intervention ABSTRACT Introduction: Severe middle cerebral artery (MCA) stenosis, as one of the intracranial atherosclerotic diseases, is a major cause of ischemic stroke. The role and optimal timing of interventions, such as angioplasty and stenting, remain subjects of debate, particularly due to the variable natural disease progression. While some cases improve spontaneously, others progress to total occlusion, necessitating comprehensive evaluation of individualized treatment approaches. Cases: This case series presents two patients with severe MCA stenosis, each of whom followed a distinct clinical courses. The first patient had 88% stenosis in the M1 segment of the right MCA (NIHSS 3, mRS 2), which spontaneously improved to 57% within days (NIHSS 2, mRS 2), with enhanced distal flow, leading to the decision to defer angioplasty and stenting. In contrast, the second patient initially had severe left MCA stenosis (NIHSS 10, mRS 4), which progressed to total occlusion within three months (NIHSS 10, mRS 4), also resulting in deferred intervention. Serial cerebral digital subtraction angiography (DSA) facilitated the observation of vascular evolution and collateral circulation, guiding decisions about intervention. Conclusion: The clinical outcomes of MCA stenosis range widely, from spontaneous resolution to progressive occlusion. Close serial imaging observation of collateral circulation and natural progression is essential for guiding decisions about angioplasty and stenting.  
Co-Authors Achmad Firdaus Sani, Achmad Firdaus Dedy Kurniawan Faishol Hamdani Faishol Hamdani Sita Setyowatie Taurus Laisari Vita Kusuma Rahmawati