Stent-assisted Coil Placement in a Wide-necked Persistent Trigeminal Artery Aneurysm with Jailing of the Trigeminal Artery: A Case Report
Mohammed I. Mohammeda,
Johnny S. Sandhua and
Ajay K. Wakhlooa
a Section of Neuroendovascular Surgery and Interventional Neuroradiology, Departments of Radiology and Neurological Surgery, University of Miami School of Medicine, FL
View larger version (84K):
[in a new window]
|
FIG 1. Right ICA angiograms obtained after failed surgical clipping of the aneurysm. Views of the wide-necked persistent TA aneurysm show the relationship of the parent vessel to the aneurysm.
A, Oblique.
B, Lateral.
| |
View larger version (59K):
[in a new window]
|
FIG 2. Angiograms illustrate stent-assisted coil placement in a persistent TA aneurysm.
A, Lateral view shows the stent bridging the aneurysm prior to deployment (arrows). The guidewire for the stent delivery system has been introduced into the angular artery. The stiff guidewire causes visible kinking of the ICA.
B, The stent is fully deployed (solid arrows), and the first detached coil, placed through the stent struts, is visible. The lower part of the coil helix covers the origin of the persistent TA (open arrow).
C, After additional coils are inserted, the first coil is pushed back into the aneurysm dome, opening the origin of the persistent TA (open arrow). The stent supports the coil mass. The small end of the coil is trapped between the vessel wall and the aneurysm (solid arrow).
| |
View larger version (75K):
[in a new window]
|
FIG 3. Lateral 9-mo follow-up angiograms.
A, Image shows complete aneurysm obliteration, a patent persistent TA, and mild narrowing of the ICA at the stented segment (arrows).
B, The distal narrowing is around the distal end of the stent (solid arrow). Further intimal hyperplasia is seen on the inner curve of the arterial wall, which already shows some minor changes prior to stent placement (open arrow) (see also Fig 1).
| |
View larger version (165K):
[in a new window]
|
FIG 4. T2-weighted (2800/90, TR/TE) MR images and MR angiograms obtained 16 mo after stent implantation.
A, MR image shows a signal void in the area of the right ICA with the stent (open arrow). Note that the stent covers the origin of the primitive TA (solid arrow).
B–G, MR images do not show any infarction from thromboembolic events. Note the old insular infarction associated with the initial diagnostic angiography.
H, 3D TOF MR angiogram depicts a signal void within the stented lumen of the right ICA and persistent TA (arrow).
| |
