A case report on middle cerebral artery aneurysm treated by rapid ventricular pacing

Abstract Rationale: Cerebral aneurysm is a common cause of intracranial hemorrhage, stroke, and death. It is treated with vascular surgeries, such as coil embolism and artery clipping. However, surgery itself is a risk factor that may cause rupture of aneurysm, and leads to irreversible brain damage, and even death. Rapid ventricular pacing (RVP) is a procedure that temporarily lowers blood pressure by increasing heart rate and reducing ventricular filling time. RVP has been widely used to reduce blood vessel tension in many cardiovascular surgeries. Patient concerns: A 46-year-old man came to our hospital with intermittent right-side headache for 5 years, and left lower limb numbness for 3 months. Diagnoses: Magnetic resonance imaging (MRI) of the head and digital subtraction angiography confirmed the diagnosis of right middle cerebral artery (MCA) aneurysm. Interventions: Considering the large size of this MCA aneurysm, RVP was used to reduce blood pressure during MCA aneurysm repair, and to lower the risk of intracranial hemorrhage during procedure. Outcomes: Post procedure, there was no abnormality detected. Seven weeks after surgery, the patient's muscle tone of right side extremities were grade V and left side extremities were grade IV. Computed tomography angiography confirmed no MCA aneurysm. Lessons: In cases of aneurysm rupture, RVP will induce a transient “very low pressure” condition, and give a valuable time frame to clip the ruptured aneurysm. Therefore RVP is a safe and effective method to provide transient reduction of cardiac output in intracranial aneurysm patients.