Article Figures & Data
Figures
- 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.
- 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.
Tables
- TABLE 1:
Clinical characteristics of 12 patients treated endovascularly during a single procedure for ruptured intracranial aneurysm and symptomatic vasospasm
Patient No. Age (yrs)/Sex Aneurysm Location Aneurysm Size Neck Size H&H Grade Fisher Group Treatment Day Vasospastic Vessel Segments 1 46/F PcomA Small Small 4 3 4 B-ICA, B-M1, B-A1, BA 2 43/F SCA Small Wide 3 3 16 BA, B-PCA 3 48/F A2 Small Small 2 3 2 B-M1, A1 4 43/M BA tip Small Small 4 3 10 B-ICA, R-M1 5 41/F AcomA Small Small 3 3 6 B-ICA, M1, A1, BA, R-P1 6 53/F BA tip Small Small 3 3 14 B-ICA, M1, A1, PCA, BA 7 54/F PICA Small Small 4 4 9 L-VA, BA, B-ICA, M1, A1 8 32/M MCA Small Small 3 3 6 L-ICA, M1 9 37/M PcomA Small Small 5 3 11 BA, R-ICA, B-M1, R-A1, L-A2 10 82/F MCA Small Small 3 3 11 R-A1, M1 11 35/M BA tip Small Small 4 3 7 B-VA, BA 12 35/F AchA Small Small 3 2 5 L-ICA, M1, A1 Note.—ACA indicates anterior cerebral artery; A1, ACA A1 segment; A2, ACA A2 segment; AchA, anterior choroidal artery; AcomA, anterior communicating artery; B-, bilateral; BA, basilar artery; H&H, Hunt and Hess; ICA, internal carotid artery; L-, left; MCA, middle cerebral artery; M1, MCA M1 segment; PCA, posterior cerebral artery; P1, PCA P1 segment; PcomA, posterior communicating artery; PICA, posterior inferior cerebellar artery; R-, right; SCA, superior cerebellar artery; VA, vertebral artery.
- TABLE 2:
Results of GDC aneurysm occlusion, endovascular treatment of vasospasm, and clinical outcome
Patient No. Treatment Order Occlusion Rate Clinical Outcome* 1 E/B, P Complete Severe disability 2 E/B Complete Good recovery 3 E/B Remnant/complete Good recovery 4 E/B Incomplete Moderate disability 5 P/E/P Remnant Severe disability 6 B, P/E/B Complete Good recovery 7 E/B, P Complete Severe disability 8 P/E/P, B Complete Good recovery 9 E/B Complete Died 10 E/P Remnant Moderate disability 11 E/B Complete Good recovery 12 E/B Complete Good recovery Note.—B indicates balloon angioplasty; E, embolization, P, papaverine.
* Glasgow Outcome Scale.
Vasospasm Clinical Outcome Good Recovery Moderate Disability Severe Disability Persistent Vegetative State Died Localized* 3 1 Diffuse† 3 1 3 1 Total 6 2 3 0 1 * Vasospasm with >50% vessel segment narrowing but localized to vascular territory of ruptured aneurysm.
† Vasospasm with >50% vessel segment narrowing but with similar degree vasospasm in other vascular territories.
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