On November 17, 2023, the teams of Professor Han Jianfeng and Professor Yu Jia from Department of Neurology of the First Affiliated Hospital (FAH) of Xi’an Jiaotong University (XJTU) successfully treated a South Korean patient with subarachnoid hemorrhage caused by the anterior communicating aneurysm rupture.

A South Korean working in Xi'an suddenly suffered from severe headache and vomiting. Head CT scan showed subarachnoid hemorrhage. Due to critical condition, the patient was transferred to Emergency Department of the FAH. The Chief Resident Physician of Department of Neurology inquired the medical history and performed physical examination of the nervous system. Combined with relevant symptoms, signs and imaging findings of the patient, the diagnosis of subarachnoid hemorrhage caused by intracranial aneurysm rupture was suspected. In Emergency Department, cranial CT scan and CTA of the head and carotid artery were also conducted. The results indicated the hemorrhage was caused by the rupture of the anterior communicating artery.

CT scan and CTA

Subsequently, the patient was admitted to ICU ward of Department of Neurology. Professor Han Jianfeng, Attending Physician Liu Fude and Resident Physician Ma Wenlong from Professor Yu Jia's team delivered medical consultations for the patient and made a preliminary diagnosis of subarachnoid hemorrhage induced by rupture of the anterior communicating aneurysm. Considering previous rupture and bleeding, the mortality rate could exceed 50% if secondary hemorrhage occurred. After collective discussion, transcatheter embolization of the anterior communicating aneurysm under general anesthesia in Emergency Department was determined. After immediate contact with Operating Room and Department of Anesthesiology, the green channel for stroke patients was established. The team attempted to communicate with family members regarding the surgery. However, because the patient is from South Korea and family members are not currently in Xi’an, the team tried to contact the patient's family members by phone to authorize the medical staff. The interventional team from Department of Neurology upheld the belief of saving lives and healing injuries and applied for the green channel of surgery to the hospital, attempting to save the life within such limited time. With full cooperation of Interventional Operating Room, Department of Anesthesiology and Perioperative Medicine and relevant departments of the hospital, the patient was urgently transferred to the Operating Room for CTA, confirming that the lesion was identified as a narrow neck anterior communicating aneurysm with a size of 2.4 mm×4.2 mm. Based on current treatment concepts and clinical guidelines for such aneurysms at home and abroad, the interventional team decided to perform transcatheteral embolization with spring coil after in-depth discussion. The team immediately informed the surgical regimen with the family, and they agreed to receive this surgery and understood relevant risks, highly recognized comprehensive strength of the interventional team, and authorized medical staff to sign relevant surgical documents. Professor Han Jianfeng and Professor Yu Jia led the interventional team to successfully complete the embolization of the anterior communicating aneurysm. Postoperative CTA showed that the anterior communicating aneurysm was not visualized and the blood flow in the anterior communicating artery was normal, indicating the "bomb" was successfully dismantled.