Published ahead of print on September 24, 2007
doi: 10.3174/ajnr.A0697
Flat Panel Detector Angiographic CT for Stent-Assisted Coil Embolization of Broad-Based Cerebral Aneurysms
G. Richtera,
T. Engelhorna,
T. Strufferta,
M. Doelkena,
O. Ganslandtb,
J. Horneggerc,
W.A. Kalenderd and
A. Doerflera
a Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
b Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany
c Department of Informatics 5, University of Erlangen-Nuremberg, Erlangen, Germany
d Department of Medical Physics, University of Erlangen-Nuremberg, Erlangen, Germany
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Fig 1. A, The basilar stem aneurysm showed complete occlusion initially after insertion of a single coil 2.5 mm in diameter: coil compaction and significant aneurysm growth in 6-month follow-up-DSA. B, Unsubtracted DSA image after insertion of a Neuroform stent (4 x 20 mm) shows the proximal and distal radiopaque markers of the stent (arrows); the stent itself is not visible. C, MIP reconstruction of ACT performed after stent deployment and before second coil embolization: excellent stent visibility and regular, complete stent deployment. The initially inserted single coil shows compaction and is distant to the parent (basilar) artery and to the stent struts as well, including one coil loop with position adjacent to stent wall, with definite extraluminal position. D, DSA. A total of 4 platinum microcoils (diameters, 2.5 and 2.0 mm, respectively) were additionally inserted. The basilar stem aneurysm shows satisfiable occlusion with minimal dog-ear remnant. E, Axial, thin (1 mm section thickness) MPR reconstruction of ACT performed after stent deployment and second coil embolization (same dataset as in F). This reconstruction allows definite exclusion of stent strut movement or coil protrusion: stent (thin arrows) without deformation adjacent to coil package (thick arrow), which causes some beam-hardening artifacts. F, MIP reconstruction (oblique coronal) of ACT performed after stent deployment and second coil embolization: excellent stent visibility without significant limitation by marginal beam-hardening artifacts through coil package; no change of stent configuration compared with the ACT imaging before the second coil embolization.
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Fig 2. A, Native, axial ACT-reconstruction, 5 mm section thickness; extensive SAH with intraventricular, hyperattenuated blood; CSF drainage adjacent to the septum pellucidum (arrow); previous frontal trepanation in the course of aneurysm clipping (anterior communicating artery); hypoattenuated brain parenchyma defect (thick arrow) with dilation of the frontal of the right lateral ventricle due to previous aneurysm rupture and parenchymal hemorrhage. B, Rotational 3D angiography with intra-arterial contrast agent injection, transparent surface shaded reconstruction (posterior-anterior view); broad-based proximal basilar stem aneurysm, forward oriented. The aneurysm base surrounds the basilar artery at least as a semicircle. C, DSA, lateral view; guidewire in the left posterior cerebral artery; Neuroform stent with proximal and distal markers (arrows). D and E, DSA (oblique views) after stent-assisted aneurysm coiling. F, MIP reconstruction of ACT after stent-assisted aneurysm coiling, providing excellent overview of the stent and the adjacent coil package; moderate beam-hardening artifacts.
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Fig 3. A, Follow-up DSA 3 months after initial coiling of the basilar artery tip aneurysm; partially reperfused aneurysm due to aneurysm growth and minimal coil compaction. B, Exchange microguidewire in the left posterior cerebral artery. C, Neuroform stent inserted, still undeployed, with radiopaque markers at the ends (arrows). Note the stretched vessel anatomy compared with B. D, Fully deployed stent, markers (arrows). E, ACT MIP reconstruction with impaired stent visibility on the level of the large coil package. F, ACT with MPR to exclude periprocedural bleeding; proximal stent marker (arrow).
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