Radiographically verified spontaneous disappearance of medium-sized arterial
cerebral aneurysms is seldom reported, and only three times in connection with
antifibrinolytic therapy (EACA). In our clinic repeat angiograms have shown non-filling of the
aneurysms in three patients during treatment with
tranexamic acid (
AMCA) two, three, and four weeks respectively after primary bleeds. Initially, all three patients had severe radiological vasospasm associated with neurological deterioration. Follow-up angiograms have demonstrated partial reappearance of the
aneurysm after one month in one patient and complete disappearance of the
aneurysms in the other two patients after 9 and 22 months respectively. In two cases occlusion of cerebral arteries occurred. With regard to the higher risk of severe vasospasm and occlusion of cerebral arteries in our opinion it should not be a therapeutic goal to try to achieve a
thrombosis of a
ruptured aneurysm with
antifibrinolytic drugs. The reason for spontaneous
aneurysm thrombosis during treatment with
AMCA may be a local inhibition of
plasminogen activators in and around the
aneurysm wall. It may also be related to the
sympathomimetic property of the
drug, with vasospasm and a subsequent flow-reduction inside the
aneurysm or a possible interaction with other drugs and substances.