Subarachnoid hemorrhage. Subarachnoid hemorrhageClinical question: R Pcomm aneurysm coilingSigns and Symptoms: R PComm aneurysmOPERATORS: Greg ChristoforidisFLUOROSCOPY TIME: 40.9 minutesFrontal: 1406.64 mGyLateral: 1785.82 mGyPROCEDURES: 1) cerebral angiogram 2) Intracranial cerebral aneurysm coil embolization with balloon assistance. 3) 3-D reconstructions of intracranial right internal carotid artery 4) Expert CT of the head without contrast. CT head: The ventriculostomy tip is located in the frontal horn of the right lateral ventricle. There is subarachnoid blood present and ventriculomegaly with intraventricular blood.Right common carotid artery: No stenosis at the carotid bifurcation on the basis of NASCET criteria. There is no evidence for carotid dissection. There is an atherosclerotic web at the right common carotid bifurcation.Right internal carotid artery: There is opacification of the right anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. The right A1 segment is small and the right A2 segment only partially opacifies. There is a 5mmx8mmx6mm aneurysm present at the origin of the right PCOMA which incorporates the origin of the PCOMA at its base.The carotid siphon and cavernous carotid have an irregular wall with mild areas of narrowing.Left common carotid artery: No evidence for carotid stenosis on the basis of NASCET criteria. There is no evidence for carotid dissection. There is mild vessel irregularity at the left common carotid bifurcation.Left internal carotid artery: There is opacification of the left anterior, middle and posterior cerebral arteries and partial opacification of the right anterior cerebral artery. The ACOMA is medium sized. Venous and parenchymal phases were within normal limits. No evidence for aneurysm, AVM or AV fistula. There is an infundibulum at the origin of the left posterior communicating artery which is fairly large and partly opacifies the right PCA.The distal cavernous segment is irregular.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 is inflow of unopacified blood into the posterior cerebral arteries and into the basilar artery.Right subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.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 transient reverse filling of the left vertebral artery and the posterior communicating arteries.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 no opacification 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. There are atherosclerotic changes along the right common, external and internal iliac arteries.
1.8mm multilobulated right posterior communicating artery aneurysm.2.Subarachnoid hemorrhage. There is a small amount of intraventricular blood present.3.Ventriculomegaly with ventriculostomy in the frontal horn of the right lateral ventricle.4.Embolic coil occlusion of right PCOMA aneurysm using MRI (up to 3T) compatible coils.5.Findings were discussed with Dr Yamini.