SAH due to aneurysm in need of embolization.OPERATORS: Greg Christoforidis, Sophia ShakurFLUOROSCOPY TIME: 45.2 minutesFrontal: 1609.8 mGyLateral: 1182.2 mGyPROCEDURES: 1) cerebral angiogram 2) Intracranial cerebral aneurysm coil embolization with balloon assistance. 3) 3-D reconstructions of intracranial right internal carotid artery Left common carotid artery: No evidence for carotid stenosis on the basis of NASCET criteria. There is no evidence for carotid dissection.Left internal carotid artery: There is opacification of the left anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. No evidence for aneurysm, AVM or AV fistula. There is inflow of unopacified blood entering the left ACA from the ACOMA.Left subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Left vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the basilar artery and both posterior cerebral arteries. There in inflow of unopacified blood entering the basilar artery and left PCA via the RVA.Right subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Right vertebral artery studied via the right subclavian injection: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the PICA and partial opacification of the basilar artery.Right common carotid artery: No stenosis at the carotid bifurcation on the basis of NASCET criteria. There is no evidence for carotid dissection.Right internal carotid artery: There is a 6mmx4mm right PCOMA aneurysm present. The right PCOMA originates from the base of the aneurysm. The right PCOMA is very small an appears to supply perforating arteries. There is opacification of the right anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. There was partial opacification of the ACOMA which was intact. The ACOMA was moderate size. The left A2 segment mildly opacified on this injection. Intraprocedural angiograms:Serial arteriograms performed during aneurysm coiling demonstrate serial occlusion of the aneurysm using balloon remodeling. The balloon remained across the neck of the aneurysm throughout the procedure.Final RICA arteriogram :At the end of the procedure there is pacification of the base of the aneurysm with preservation of the PCOMA and anterior choroidal artery and no thromboembolic events.Right common iliac artery: No contraindications to closure device.
1.Right PCOMA aneurysm2.Embolization of right PCOMA aneurysm with residual based. The PCOMA originates from the base of the aneurysm and did not depict opacification of the p1 segment. Rather is supplies the thalamotuberal artery and possibly additional perforating arteries.3.Findings were reported to Dr Awad at the end of the procedure.