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AJNR - American Journal of Neuroradiology

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Heparin-Induced Thrombocytopenia in a Case of Endovascular Aneurysm Coiling

V. Gupta^a, R. Tanvir^a, A. Garg^a, S.B. Gaikwad^a and N.K. Mishra^a

^a From the Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India

View larger version (154K): [in this window] [in a new window]   Fig 1. Digital subtraction angiography (lateral view) of right (A) and left (B) internal carotid arteries shows occlusion of both vessels beyond the origin of the ophthalmic artery. Hypertrophy of perforator arteries likely to provide collateral flow (more prominent on the left side) is noted. Left vertebral artery injection: anteroposterior (C) and lateral (D) views show hypertrophied posterior communicating arteries supplying the anterior circulation. Aneurysms are noted in the left AICA (arrow), the left PICA (arrowhead), and the left posterior cerebral artery (double arrow). The small posterior cerebral artery aneurysm was better profiled in 3D angiograms (not shown).

View larger version (149K): [in this window] [in a new window]   Fig 2. Images depicting embolization of the left AICA aneurysm. The bilobed AICA aneurysm was better profiled in oblique view (A). Although the aneurysm was filling well after detachment of the first coil (B), a repeat angiogram after a few minutes shows complete occlusion of the aneurysm (C). Progressive thrombus formation was noticed in a repeat angiogram done after a few minutes, which shows a small thrombus projecting into the basilar artery from the neck of the aneurysm (D).

View larger version (134K): [in this window] [in a new window]   Fig 3. Images depicting coiling of the left PICA aneurysm. The aneurysm (A) was coiled with two detachable coils. Although residual aneurysm filling with well patent left PICA was seen after detachment of the second coil (B), a repeat angiogram done after a few minutes shows almost complete occlusion of the aneurysm with marked slowing of flow in the PICA (C). Abciximab infusion near the neck shows a patent PICA (D).