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Endovascular Treatment of Intracranial Aneurysms with a Branch Arising from the Sac

B. Lubicza, F. Lefrancb, M. Levivierb, O. Dewitteb, B. Pirotteb, J. Brotchib and D. Balériauxa

a Department of Neuroradiology, Erasme University Hospital, Brussels, Belgium
b Department of Neurosurgery, Erasme University Hospital, Brussels, Belgium



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  		Fig 1. Unruptured MCA aneurysm in a 48-year-old woman treated by selective embolization.

A, Conventional angiogram shows a 5-mm aneurysm of the proximal MCA.

B, 3D angiogram shows a sylvian branch arising from the sac.

C, HyperForm remodeling balloon overinflated in the M1 segment. A part of the balloon is clearly bulging within the aneurysmal sac to protect the arterial branch.

D–F, Final angiographic result: conventional subtracted (D), unsubtracted (E), and 3D (F) angiograms show a neck remnant and the preservation of the arterial branch.



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  		Fig 2. Unruptured MCA aneurysm in a 56-year-old woman.

Conventional (A) and 3D (B) angiograms show a wide-necked M1 aneurysm with a branch arising from the sac.

C, Conventional angiogram at the end of the embolization shows an asymmetric reconstruction of the neck with patency of the arterial branch.



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  		Fig 3. SAH in a 74-year-old woman.

Conventional (A) and 3D (B) angiograms show a wide-necked PcomA aneurysm with the fetal-type PcomA arising from the mid-third of the sac.

Conventional subtracted (C) and unsubtracted (D) angiograms at the end of the embolization show an incomplete aneurysm occlusion and the preservation of the PcomA.



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  		Fig 4. SAH in a 64-year-old woman.

Conventional (A) and 3D (B) angiograms show a 20-mm aneurysm of the left ICA bifurcation with the A1 segment arising from the sac.

C, A balloon test occlusion shows the efficient collateral circulation through the AcomA.

D, Conventional angiogram at the end of the embolization shows a complete aneurysm occlusion and the sacrifice of the origin of the left A1 segment.



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  		Fig 5. SAH in a 73-year-old man with a ruptured AcomA aneurysm previously wrapped 4 years before.

Conventional (A) and 3D (B and C) angiograms show a 10-mm AcomA aneurysm with the right A2 segment arising from the sac (arrow).

D, Conventional angiogram shows a first "stabilizing" 3D coil of 10 mm placed with fewest loops in front of the arterial branch.

E, Conventional angiogram shows a second and smaller (5-mm coil) 3D cage placed in the aneurysm inflow zone (arrow).

Conventional unsubtracted (F) and subtracted (G) angiograms at the end of the embolization show an incomplete aneurysm occlusion and the patency of the arterial branch.

H, Angiographic control at one week shows a further aneurysm thrombosis with preservation of the arterial branch.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X