Title: 85 year old white male presents with Grade III subarachnoid hemorrhage'
185 year old white male presents with Grade III
subarachnoid hemorrhage.
2Angiography reveals large anterior communicating
artery aneurysm (arrow).
3Aneurysm is catheterized. Coils are placed
(arrows).
4Post embolization there is minimal residual neck
with preservation of anterior communicating
artery. Neck eventually obliterates.
5Postoperative coil mass is shown (arrow).
664 year old white male presents with grade II
subarachnoid hemorrhage.
7Angiography reveals bilobular aneurysm at A-1/A-2
junction of left anterior cerebral artery (arrow)
8Aneurysm is catheterized and completely embolized
(arrows).
935 year old asian female presents with grade II
subarachnoid hemorrhage.
10Angiography reveals bilobular wide necked
aneurysm of left anterior cerebral artery A-1 and
A-2 junction (arrow).
11Aneurysm is catheterized (arrow). Contralateral
carotid catheterization/injection is used to
monitor right anterior cerebral artery patency
12Balloon catheter is placed across aneurysm neck
(arrows) following aneurysm catheterization
(arrowhead).
13Balloon remodeling technique is employed to
embolize wide necked aneurysm and preserve parent
vessel (arrows)
14Post embolization there is 100 aneurysm
occlusion (arrows) with parent vessel preservation
1566 year old WM presents with grade I SAH due to
ruptured wide necked basilar apex aneurysm
(arrow).
16Balloon remodeling employed (arrowheads).
However there is significant residual dysplastic
neck (arrow).
17Stent is deployed from right posterior cerebral
artery to basilar artery, covering aneurysm neck
(arrows).
18Basilar apex is completely reconstructed with
preservation of basilar quadrification vessels
1965 year old white male presents with grade IV
subarachnoid hemorrhage due to anterior
communicating artery aneurysm (arrow). Vasospasm
is present (arrow heads)
20The anterior cerebral artery is selected and
vasospasm is treated with verapamil infusion
(arrow), restoring ACA caliber
21100 aneurysm obliteration is achieved (arrow).
2252 year old hispanic male presents with grade III
subarachnoid hemorrhage and cerebral vasospasm
from anterior communicating aneurysm rupture
23Aneurysm is selected (arrow) and coils deployed.
24Aneurysm is 100 obliterated (long arrow) and
vasospasm is treated with right ACA verapamil
infusion (short arrow)
2580 year old asian female presents with grade
II-III subarachoid hemorrhage and hydrocephalus
26Left carotid injection reveals posterior
communicating artery aneurysm (arrow).
27Embolization results in aneurysm obliteration
(arrow).
2860 year old hispanic female with history of
subarachnoid hemorrhage from right carotid
aneurysm presents with unruptured, small wide
necked left carotid aneurysm
29In first stage of treatment, stent is deployed in
paraclinoid carotid across aneurysm neck
(arrows). Note previous right sided aneurysm
clip (arrow head).
308 weeks later, the patient returns for stent
supported embolization. The aneurysm is
catheterized (arrow).
31Aneurysm is obliterated in 2nd stage
stent-supported treatment (arrows)
32MR angiogram reveals aneurysm (arrow) in middle
aged white female complaining of headache.
33Angiogram reveals posterior communicating artery
aneurysm with apparent filling defect (arrow)
34Balloon catheter is placed in right posterior
communicating artery (short arrows). 2nd
catheter placed in aneurysm. Balloon assisted
embolization (long arrow) is performed
35A different view reveals that there is a second,
adjacent aneurysm off the posterior communicating
artery. This is embolized.
36Final postoperative angiogram showing
obliteration of both aneurysms
3769 year old WF presents with incidental right
ophthalmic artery aneurysm
38Aneurysm is catheterized (arrow) and balloon is
placed across aneurysm neck (arrow heads)
39Embolization with temporary balloon occlusion
assist is carried out
40Due to coil herniation a stent is placed in
carotid. There is small residual neck,
eventually thrombosing