Combined Endovascular Treatment for Both Intracranial Aneurysm and Symptomatic Vasospasm
Yuichi Murayamaa,
Joon K. Songa,
Ken Udaa,
Y. Pierre Gobina,
Gary R. Duckwilera,
Satoshi Tateshimaa,
Aman B. Patela,
Neil A. Martinb and
Fernando Viñuelaa
a Division of Interventional Neuroradiology, Department of Radiology, University of California at Los Angeles, School of Medicine and Medical Center, Los Angeles
b Section of Neurovascular Surgery, Division of Neurosurgery, Department of Surgery, University of California at Los Angeles, School of Medicine and Medical Center, Los Angeles
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FIG 1. Patient 6, a 53-year-old woman with a ruptured basilar tip aneurysm 14 days after initial hemorrhage.
A and B, Left vertebral artery angiograms, frontal (A) and lateral (B) projections, show severe vasospasm of the basilar artery and posterior cerebral arteries. Present is a basilar tip (single solid arrow) and aneurysm (double solid arrows) complex pointing posteriorly. Note thalamoperforators (open arrow) appearing to arise from the basilar tip.
C, Left vertebral artery angiogram, frontal projection, shows partial coiling of the aneurysm.
D and E, Left vertebral artery angiograms, frontal (D) and lateral (E) projections obtained after embolization of the aneurysm and balloon angioplasty, show improved caliber of the midbasilar artery. Note residual vasospasm still exists at the origin of aneurysm entry zone.
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FIG 2. Patient 8, a 32-year-old man with a 2-mm left middle cerebral bifurcation aneurysm 6 days after rupture.
A, Left internal carotid artery angiogram, frontal projection, shows the aneurysm as well as focal severe vasospasm of the left M1 and M2 segments of the middle cerebral artery.
B, After intraarterial papaverine infusion in the left anterior circulation, the left M1 and M2 segments have increased in caliber.
C, A microcatheter is positioned at the base of the aneurysm after careful positioning of a 2-mm GDC-10 coil within the aneurysm.
D, Left internal carotid artery angiogram obtained after embolization, intraarterial thrombolysis, and balloon angioplasty shows improved caliber of treated vessel segments and open prefrontal middle cerebral artery branch.
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