85 year old white male presents with Grade III subarachnoid hemorrhage'

1
85 year old white male presents with Grade III
subarachnoid hemorrhage.
2
Angiography reveals large anterior communicating
artery aneurysm (arrow).
3
Aneurysm is catheterized. Coils are placed
(arrows).
4
Post embolization there is minimal residual neck
with preservation of anterior communicating
artery. Neck eventually obliterates.
5
Postoperative coil mass is shown (arrow).
6
64 year old white male presents with grade II
subarachnoid hemorrhage.
7
Angiography reveals bilobular aneurysm at A-1/A-2
junction of left anterior cerebral artery (arrow)
8
Aneurysm is catheterized and completely embolized
(arrows).
9
35 year old asian female presents with grade II
subarachnoid hemorrhage.
10
Angiography reveals bilobular wide necked
aneurysm of left anterior cerebral artery A-1 and
A-2 junction (arrow).
11
Aneurysm is catheterized (arrow). Contralateral
carotid catheterization/injection is used to
monitor right anterior cerebral artery patency
12
Balloon catheter is placed across aneurysm neck
(arrows) following aneurysm catheterization
(arrowhead).
13
Balloon remodeling technique is employed to
embolize wide necked aneurysm and preserve parent
vessel (arrows)
14
Post embolization there is 100 aneurysm
occlusion (arrows) with parent vessel preservation
15
66 year old WM presents with grade I SAH due to
ruptured wide necked basilar apex aneurysm
(arrow).
16
Balloon remodeling employed (arrowheads).
However there is significant residual dysplastic
neck (arrow).
17
Stent is deployed from right posterior cerebral
artery to basilar artery, covering aneurysm neck
(arrows).
18
Basilar apex is completely reconstructed with
preservation of basilar quadrification vessels
19
65 year old white male presents with grade IV
subarachnoid hemorrhage due to anterior
communicating artery aneurysm (arrow). Vasospasm
is present (arrow heads)
20
The anterior cerebral artery is selected and
vasospasm is treated with verapamil infusion
(arrow), restoring ACA caliber
21
100 aneurysm obliteration is achieved (arrow).
22
52 year old hispanic male presents with grade III
subarachnoid hemorrhage and cerebral vasospasm
from anterior communicating aneurysm rupture
23
Aneurysm is selected (arrow) and coils deployed.
24
Aneurysm is 100 obliterated (long arrow) and
vasospasm is treated with right ACA verapamil
infusion (short arrow)
25
80 year old asian female presents with grade
II-III subarachoid hemorrhage and hydrocephalus
26
Left carotid injection reveals posterior
communicating artery aneurysm (arrow).
27
Embolization results in aneurysm obliteration
(arrow).
28
60 year old hispanic female with history of
subarachnoid hemorrhage from right carotid
aneurysm presents with unruptured, small wide
necked left carotid aneurysm
29
In first stage of treatment, stent is deployed in
paraclinoid carotid across aneurysm neck
(arrows). Note previous right sided aneurysm
clip (arrow head).
30
8 weeks later, the patient returns for stent
supported embolization. The aneurysm is
catheterized (arrow).
31
Aneurysm is obliterated in 2nd stage
stent-supported treatment (arrows)
32
MR angiogram reveals aneurysm (arrow) in middle
aged white female complaining of headache.
33
Angiogram reveals posterior communicating artery
aneurysm with apparent filling defect (arrow)
34
Balloon catheter is placed in right posterior
communicating artery (short arrows). 2nd
catheter placed in aneurysm. Balloon assisted
embolization (long arrow) is performed
35
A different view reveals that there is a second,
adjacent aneurysm off the posterior communicating
artery. This is embolized.
36
Final postoperative angiogram showing
obliteration of both aneurysms
37
69 year old WF presents with incidental right
ophthalmic artery aneurysm
38
Aneurysm is catheterized (arrow) and balloon is
placed across aneurysm neck (arrow heads)
39
Embolization with temporary balloon occlusion
assist is carried out
40
Due to coil herniation a stent is placed in
carotid. There is small residual neck,
eventually thrombosing