15 years old female with a giant vertebrobasilar aneurysm. Please provide endovascular treatment. Left subclavian artery: There is no evidence for arteriovenous fistula. No pseudoaneurysms in the V1-V3 segments of the LVA. There is aneurysmal dilation of the LVA at the V4 segment.Right subclavian artery: There is no evidence for arteriovenous fistula. There is no evidence for evidence for vertebral dissection. There is no stenosis at the origin of the right vertebral artery. No pseudoaneurysms in the V1-V3 segments of the RVA.Left vertebral artery:There is a giant vertebrobasilar aneurysm present. LVA is displaced laterally. There is a partially thrombosed 42x34x34 mm giant aneurysm at the distal left vertebral artery and vertebrobasilar junction. The LVA ends in the aneurysm. There is a vascular tunnel through the thrombosed aneurysm. The LVA is the dominant supply to the aneurysm. There is extracranial left PICA origin.Right vertebral artery: There is filling of the distal aspect of the giant vertebrobasilar aneurysm. RVA is displaced laterally. There is a 18 mm dilated segment of the RVA of which the distal 10mm open into the aneurysm. The RVA is the dominant supply to the basilar artery. There is reverse filling of the left PCOMA with partial opacification of the left middle cerebral artery. There is an inflow jet of unopacified blood entering via the LVA. The RVA is fenestrated at the level of the extracranial right PICA. The PICA originates from the larger loop.The anterior spinal artery has a dominant right C5 segmental artery supply which also supplies medulla.Right common carotid artery: There is no stenosis at the carotid bifurcation on the basis of NASCET criteria. There is no evidence for carotid dissection or pseudoaneurysm. Right internal carotid artery: There is opacification of the right anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits. There is no angiographic evidence for vasculitis. There is partial opacification of he left anterior cerebral artery.Left common carotid artery: There is no evidence for carotid stenosis on the basis of NASCET criteria. There is an aneurysm measuring approximately 16x26mm at the C1 vertebral body level along the lateral aspect of the left ICA which displaces the LICA medially and mildly narrows it. Approximately 12 mm distal to the LICA origin there is an approximately 4.5x3mm sessile aneurysm present.Left internal carotid artery: There is opacification of the left anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits. There is a large aneurysm at the C1 vertebral body level along the lateral aspect of the left ICA which displaces the LICA medially and mildly narrows it. Approximately 20 mm distal to the LICA origin there is a 7x5mm sessile aneurysm present. There is opacification of some of the distal right ACA vasculature (superior internal parietal artery).Left external carotid artery: There is no evidence for arteriovenous fistula. There is no evidence for AVM. There is no angiographic evidence for vasculitis. No aneurysms are identified.Intraprocedural angiograms:Serial arteriograms performed the during the LVA occlusion demonstrate progressive occlusion of the LVA. Serial arteriograms performed the during the stent assisted aneurysm coiling demonstrate serial occlusion of the aneurysm. At the end of the procedure there is opacification of the base of the aneurysm. Presumably the stents extend into the base.Right vertebral artery: There is opacification of the base of the aneurysm. Presumably the stents extend into the base. The RVA is displaced laterally. There is a 18 mm dilated segment of the RVA of which the distal 10mm open into the aneurysm. The stents are deployed from the basilar artery just below AICA origin to the more normal appearing RVA distal to the PICA. The RVA is the exclusive supply to the basilar artery. There is some unopacified blood entering via the left PCOMA. There is transient reverse filling of the left PCOMA with partial opacification of the left middle cerebral artery. The RVA is fenestrated at the level of the extracranial right PICA. The PICA originates from the larger loop.The anterior spinal artery has a dominant right C5 segmental artery supply which also supplies medulla.Right common iliac artery: The right profunda femoris artery originates proximal to the puncture site.Left common iliac artery: No anatomic contraindications to closure device.
1.Vertebrobasilar giant aneurysm primarily involving the LVA but also involving V-B junction and RVA.2.There are two dissecting aneurysms along the left cervical ICA. A larger one measuring is at the C1 level and a smaller one is just distal to the carotid bulb.3.Embolic coil occlusion of left vertebral artery (LVA) distal to the PICA.4.Stent assisted coiling of vertebrobasilar junction giant aneurysm using Neuroform stent system. These are MRI compatible devices up to 3 T.5.Findings were discussed with Dr Awad and Dr Ardelt at the end of the procedure.