Diagnosis: Subarachnoid hemorrhageClinical question: Evaluate for aneurysmSigns and Symptoms: Diffuse SAH, no clear etiology seen on CTAOPERATORS: Greg Christoforidis, Sophia ShakurFLUOROSCOPY TIME: 24.3 minutesFrontal: 1105.19 mGyLateral: 644.54 mGyPROCEDURES: 1) cerebral angiogram 2) Intracranial cerebral aneurysm coil embolization with balloon assistance. 3) 3-D reconstructions of intracranial right internal carotid artery 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 was transient opacification of the ACOMA which was intact. The ACOMA was moderate size. 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. There is no evidence for aneurysm, AVM or AV fistula.Left vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the basilar artery and both posterior cerebral arteries. There is extracranial origin of the left posterior inferior cerebellar artery. There is double origin of the left posterior inferior cerebellar artery from the V3 and V2 segments. There is no evidence for aneurysm, AVM or AV fistula.Right vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the basilar artery and both posterior cerebral arteries. There is extracranial origin of the right posterior inferior cerebellar artery. The posterior falx artery originates from the right vertebral artery. There is supply to the anterior spinal artery.Intraprocedural angiograms:Serial arteriograms performed during aneurysm coiling demonstrate serial occlusion of the aneurysm. The balloon remained across the neck of the aneurysm throughout the procedure.Final RICA arteriogram :At the end of the procedure there is no opacification of the aneurysm dome with a small residual base which contains a coil loop. There was preservation of the PCOMA and anterior choroidal artery and no thromboembolic events.Right common iliac artery: No contraindications to closure device.
1.2mm right communicating segment aneurysm2.Embolic coil occlusion of 2mm right communicating segment aneurysm using MRI compatible embolic occlusion coils.3.Findings were discussed with Dr Awad after the procedure.