Single-session Coil Embolization of Multiple Intracranial Aneurysms
A 47-year-old woman presented with a severe headache of sudden onset with a stuporous mentality (HHG III). The initial CT scan revealed diffuse SAH (Fisher grade III) in the basal cistern and dense focal intracranial hemorrhage (ICH) in the interhemispheric fissure with intraventricular hemorrhage (IVH) (). The left internal carotid angiogram demonstrated a 4.5-mm pericallosal (A2) aneurysm with a relatively wide neck and a 6-mm sized middle cerebral artery bifurcation aneurysm with a wide neck (). The right internal carotid angiogram showed a 4.5-mm sized MCA bifurcation aneurysm with a wide neck (). We decided that the left pericallosal artery aneurysm was the cause of bleeding because of its proximity to the ICH. All 3 of these aneurysms were embolized in a single procedure. Under general anesthesia, a 6F guiding catheter was placed at the left ICA. The ruptured pericallosal aneurysm was selected with a microcatheter, and 4 detachable coils were delivered into the aneurysm lumen (). After confirming complete obliteration of the pericallosal aneurysm, the left MCA bifurcation aneurysm was selected with the same microcatheter. Although the aneurysm was wide-necked, the initial coil deployed provided a stable frame for 5 additional detachable coils into the aneurysm sac. Repeated angiogram showed a nearly complete embolization of the MCA bifurcation aneurysm and good patency of the MCA (). Finally, we repositioned the same guiding catheter to the right ICA. Five detachable coils were enough for near-complete obliteration (). The course of procedure and subsequent recovery was uneventful. The patient did not experience post-procedural contrast-induced complications. A follow-up magnetic resonance angiography confirmed continued occlusion of aneurysms and wide patency of the parent arteries ().