Thunderclap headache with multiple aneurysms please provide embolic coil occlusion of basilar artery aneurysm and anterior choroidal artery aneurysm and identify any additional aneurysms.OPERATORS: Greg ChristoforidisFLUOROSCOPY TIME: 91 minutesFrontal: 5098.27 mGyLateral: 2433.26 mGyPROCEDURES: 1) cerebral angiogram 2) Intracranial right anterior choroidal artery cerebral aneurysm coil embolization with balloon assistance. 3) 3-D reconstructions of intracranial right internal carotid artery. 4) Intracranial left anterior inferior cerebellar artery basilar cerebral aneurysm coil embolization with balloon assistance.5) 3-D reconstructions of right vertebral artery 6) thrombolysis of anterior choroidal artery thrombus 7) thrombolysis of anterior inferior cerebellar artery thrombus. 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 opacification of the right anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. There is a 7 mm bilobed aneurysm present at the origin of the right anterior choroidal artery. The anterior choroidal artery originates at the base of the aneurysm.There is a 2 mm irregular aneurysm at the origin of the right ophthalmic 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 and middle cerebral arteries. There is an infundibulum at the origin of the left posterior communicating arteryVenous and parenchymal phases were within normal limits. No evidence for aneurysm, AVM or AV fistula. Left subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Left vertebral artery: There is opacification of the basilar artery and both posterior cerebral arteries. There is a 4 mm aneurysm at the origin of the left anterior inferior cerebellar artery. The left anterior inferior cerebellar artery originates from the base of the aneurysm.There is a 1 mm aneurysm at the origin of the left superior cerebellar artery.Right subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Right vertebral artery: There is opacification of the basilar artery and both posterior cerebral arteries. There is a 4 mm aneurysm at the origin of the left anterior inferior cerebellar artery. The left anterior inferior cerebellar artery originates from the base of the aneurysm.There is a 1 mm aneurysm at the origin of the left superior cerebellar artery.Intraprocedural angiograms:Serial arteriograms performed during aneurysm coiling demonstrate serial occlusion of the right anterior choroidal artery aneurysm aneurysm using balloon remodeling. There is transient partial occlusion of the right prefrontal artery which resolved after heparin administration. The balloon remained across the neck of the aneurysm. There was thrombus formation at the base of the aneurysm extruded into the right internal carotid artery and the one lobe of the aneurysm only had a couple coil loops buttock was thrombosed. There was transient occlusion of the right anterior choroidal artery aneurysm which resolved after thrombolytic treatment.Serial arteriograms performed during aneurysm coiling demonstrate serial occlusion of the left anterior inferior cerebellar artery/basilar artery aneurysm using balloon remodeling. A small amount of nonocclusive thrombus which formed at the origin of the left anterior inferior cerebellar artery resolved.Final RVA arteriogram :There is opacification of the basilar artery and both posterior cerebral arteries. The mid basilar artery aneurysm at the origin of the left anterior inferior cerebellar artery is occluded. No thromboembolic events are appreciated. There is a 1 mm left superior cerebellar artery aneurysm present.Final RICA arteriogram :At the end of the procedure there is no opacification of the aneurysm with preservation of the PCOMA and anterior choroidal artery and no thromboembolic events. No new thromboembolic events are appreciated.Right common iliac artery: No contraindications to closure device.
1.Right anterior choroidal artery aneurysm.2.Basilar artery aneurysm at the origin of the left anterior inferior cerebellar artery.3.Right ophthalmic artery aneurysm measures approximately 2 mm in size and is rather fusiform and irregular4.Left superior cerebellar origin 1 mm aneurysm.5.Embolic coil occlusion of a right anterior choroidal artery aneurysm using MRI compatible (up to 3T) coils. This aneurysm partially thrombosed. At the end of the procedure was completely occluded and no coils were placed in the thrombosed portion.6.Embolic coil occlusion of the basilar artery aneurysm at the origin of the left anterior inferior cerebellar artery.7.Transient occlusion of the right anterior choroidal artery during the procedure was treated with intraarterial thrombolytic infusion (ReoPro). There was a thrombus formation at the base of both aneurysms but predominantly the anterior choroidal artery aneurysm. The patient received a total 5000 units of heparin during the procedure, 7mg ReoPro and 5 mg verapamil in order to help treat thrombus formation.8.The findings were discussed with Dr. Goldenberg and Dr Yamini. The patient will be capped mildly anticoagulated overnight.