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Slide 1

  1. 1. 85 year old white male presents with Grade III subarachnoid hemorrhage.
  2. 2. Angiography reveals large anterior communicating artery aneurysm (arrow).
  3. 3. Aneurysm is catheterized. Coils are placed (arrows).
  4. 4. Post embolization there is minimal residual neck with preservation of anterior communicating artery. Neck eventually obliterates.
  5. 5. Postoperative coil mass is shown (arrow).
  6. 6. 64 year old white male presents with grade II subarachnoid hemorrhage.
  7. 7. Angiography reveals bilobular aneurysm at A-1/A-2 junction of left anterior cerebral artery (arrow)
  8. 8. Aneurysm is catheterized and completely embolized (arrows).
  9. 9. 35 year old asian female presents with grade II subarachnoid hemorrhage.
  10. 10. Angiography reveals bilobular wide necked aneurysm of left anterior cerebral artery A-1 and A-2 junction (arrow).
  11. 11. Aneurysm is catheterized (arrow). Contralateral carotid catheterization/injection is used to monitor right anterior cerebral artery patency
  12. 12. Balloon catheter is placed across aneurysm neck (arrows) following aneurysm catheterization (arrowhead).
  13. 13. Balloon remodeling technique is employed to embolize wide necked aneurysm and preserve parent vessel (arrows)
  14. 14. Post embolization there is 100% aneurysm occlusion (arrows) with parent vessel preservation
  15. 15. 66 year old WM presents with grade I SAH due to ruptured wide necked basilar apex aneurysm (arrow).
  16. 16. Balloon remodeling employed (arrowheads). However there is significant residual dysplastic neck (arrow).
  17. 17. Stent is deployed from right posterior cerebral artery to basilar artery, covering aneurysm neck (arrows).
  18. 18. Basilar apex is completely reconstructed with preservation of basilar quadrification vessels
  19. 19. 65 year old white male presents with grade IV subarachnoid hemorrhage due to anterior communicating artery aneurysm (arrow). Vasospasm is present (arrow heads)
  20. 20. The anterior cerebral artery is selected and vasospasm is treated with verapamil infusion (arrow), restoring ACA caliber
  21. 21. 100% aneurysm obliteration is achieved (arrow).
  22. 22. 52 year old hispanic male presents with grade III subarachnoid hemorrhage and cerebral vasospasm from anterior communicating aneurysm rupture
  23. 23. Aneurysm is selected (arrow) and coils deployed.
  24. 24. Aneurysm is 100% obliterated (long arrow) and vasospasm is treated with right ACA verapamil infusion (short arrow)
  25. 25. 80 year old asian female presents with grade II-III subarachoid hemorrhage and hydrocephalus
  26. 26. Left carotid injection reveals posterior communicating artery aneurysm (arrow).
  27. 27. Embolization results in aneurysm obliteration (arrow).
  28. 28. 60 year old hispanic female with history of subarachnoid hemorrhage from right carotid aneurysm presents with unruptured, small wide necked left carotid aneurysm
  29. 29. In first stage of treatment, stent is deployed in paraclinoid carotid across aneurysm neck (arrows). Note previous right sided aneurysm clip (arrow head).
  30. 30. 8 weeks later, the patient returns for stent supported embolization. The aneurysm is catheterized (arrow).
  31. 31. Aneurysm is obliterated in 2nd stage stent-supported treatment (arrows)
  32. 32. MR angiogram reveals aneurysm (arrow) in middle aged white female complaining of headache.
  33. 33. Angiogram reveals posterior communicating artery aneurysm with apparent filling defect (arrow)
  34. 34. Balloon catheter is placed in right posterior communicating artery (short arrows). 2nd catheter placed in aneurysm. Balloon assisted embolization (long arrow) is performed
  35. 35. A different view reveals that there is a second, adjacent aneurysm off the posterior communicating artery. This is embolized.
  36. 36. Final postoperative angiogram showing obliteration of both aneurysms
  37. 37. 69 year old WF presents with incidental right ophthalmic artery aneurysm
  38. 38. Aneurysm is catheterized (arrow) and balloon is placed across aneurysm neck (arrow heads)
  39. 39. Embolization with temporary balloon occlusion assist is carried out
  40. 40. Due to coil herniation a stent is placed in carotid. There is small residual neck, eventually thrombosing
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