Thrombus Formation at the Neck of Cerebral Aneurysms during Treatment with Guglielmi Detachable Coils
Michael J. Workmana,
Harry J. Clofta,
Frank C. Tonga,
Jacques E. Diona,
Mary E. Jensenb,
William F. Marxb and
David F. Kallmesb
a Department of Radiology, Emory University Hospital, Atlanta, GA
b Department of Radiology, University of Virginia Health Sciences Center, Charlottesville, VA
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FIG 1. Images from the case of a 54-year-old female patient with giant ophthalmic artery aneurysm remnant.
A, Right internal carotid artery injection, oblique projection. Mask artifact outlines the margin of the dense coil pack filling the giant ophthalmic artery aneurysm. The first coil has been detached within the remnant at the aneurysm base (black arrow). Note GDCs within a previously embolized middle cerebral artery bifurcation aneurysm (arrowhead).
B, After completion of the embolization procedure, control angiogram shows a small, poorly marginated, hazy opacity at the coil-parent artery interface, suggesting early thrombus formation (arrow).
C, Repeat angiogram obtained 25 minutes later shows marked increase in thrombus burden at the coil surface and in the parent artery.
D, Forty minutes after the administration of the abciximab bolus, near-complete resolution of thrombus at the coil surface can be seen.
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FIG 2. Images from the case of a 49-year-old male patient with a basilar tip aneurysm.
A, Angiogram of the left vertebral artery, transfacial projection. The basilar tip aneurysm is packed with GDCs (short arrows). A linear filling defect with hazy margins, consistent with thrombus, is present in the distal basilar artery and extends into the right P1 segment (long arrows).
B, Angiogram of the left vertebral artery, transfacial projection. After 24 hours of heparin infusion, follow-up angiogram obtained after GDC treatment shows resolution of thrombus. However, there is partial recanalization of the aneurysm centrally.
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FIG 3. Images from the case of a 57-year-old female patient with a superior hypophyseal artery aneurysm.
A, Control angiogram of the right internal carotid artery, contralateral transorbital oblique projection. The superior hypophyseal artery aneurysm is tightly packed with GDCs (arrowheads). Thrombus has formed at the coil-parent artery interface, manifesting as a filling defect with a lobular contour with hazy margins (white arrow).
B, Control angiogram obtained 10 minutes after the administration of the Integrilin bolus shows resolution of thrombus at the coil-parent artery interface.
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