Article Figures & Data
Figures
- Fig 1.
Case 1, a 54-year-old man with SAH.
A, Right internal carotid angiogram shows a large aneurysm of middle cerebral artery bifurcation. The inferior division (M2) is incorporated with the neck.
B, The aneurismal configurations are visualized in 3D image.
C, Two microcatheters with different markers are positioned within the aneurysm. The microcatheters have different distal shaping.
D, Two coils (GDC-10; 5 mm × 15 cm) deployed via two microcatheters. Each coil occupies different parts of the aneurysm, and simultaneously they are mixed at the central part. In this case, to make a more complicated mixture of the two coils, the second coil is being advanced before complete deployment of the first coil.
E, After detachment of the first coil, the third coil advanced within the aneurysm. The second coil is not detached until a more stable coil mass is obtained.
F, Angiogram obtained immediately after embolization shows compact occlusion of the aneurismal sac and patent inferior division (M2). There is small neck remnant around the inferior division.
- Fig 2.
Case 12, an 80-year-old woman with Hunt and Hess grade 4 SAH.
A, Angiogram shows a large aneurysm of fetal type posterior communicating artery.
B, 3D image of the same aneurysm.
C, Two coils (GDC-10–2D; 7 mm × 25 cm, 5 mm × 15 cm) are being deployed via two microcatheters.
D, Final angiogram shows residual neck to preserve the fetal type posterior communicating artery. The dome of the aneurysm is compactly occluded.
- Fig 3.
Case 25, a 38-year-old man with Hunt and Hess grade 2 SAH. Initially, surgical clipping had been planned, but embolic occlusion of MCA branches occurred during diagnostic angiography. Right upper-extremity monoplegia and motor dysphasia developed. For rescue thrombolysis, urgent endovascular occlusion of the aneurysm was performed.
A, Angiogram shows an aneurysm of MCA bifurcation. The superior division (M2) arises from the fundus of the aneurysm.
B, Clearer aneurismal configurations are viewed in 3D image.
C, Two microcatheters are placed within the aneurysm. Note the position of the microcatheters.
D, To protect the superior division (M2), several centimeters of a small coil (GDC-10-soft-SR; 2 mm × 8 cm) are deployed first through one microcatheter near the origin of the superior division (arrow), and this coil is interfering with movement of the second coil (GDC-10–3D; 3 mm × 8 cm) toward the superior division (M2).
E, After achieving a stable coil frame without compromise of the M2, the first coil that had been used for protection of the superior division was carefully retrieved without movement of the coil frame, and, after changing the microcatheter position, it was reinserted into the coil mass.
F, Final angiogram shows complete occlusion of the aneurysm and patent both M2. After the procedure, the patient recovered without neurologic deficit.
Tables
Summary of the 25 patients with 25 aneurysms
Patient no. Sex/Age SAH (grade) Aneurysm location Neck, mm Height, mm Width, mm W/H ratio D(H)/N ratio Occlusion Purpose for IR Outcomes, mRS 1 M/54 3 MCAb 7.5 9.00 11 1.22 1.2000 NR 0 2 F/33 unruptured MCAb 4.0 2.60 6.5 2.5 0.6500 complete 0 3 M/43 2 MCAb 5.3 5.00 7 1.4 0.9434 complete 0 4 M/43 unruptured Basilar 7.5 7.00 7.5 1.07 0.9333 complete 0 5 F/54 2 Basilar 13.0 16.00 16 1 1.2308 IR, neck preservation of P1 0 6 F/66 2 Basilar 12.0 16.00 13 0.81 1.3333 IR, neck preservation of P1 0 7 M/66 unruptured Basilar 16.0 19.00 10 0.53 1.1875 IR, neck preservation of P1 0 8 M/64 unruptured Basilar 8.0 6.00 15 2.5 0.7500 IR, neck preservation of P1 0 9 F/59 3 Basilar 12.0 16.00 18 1.13 1.3333 complete 0 10 F/52 unruptured Basilar 8.0 9.50 13 1.37 1.1875 IR, neck preservation of P1 0 11 M/60 unruptured Mid-Basilar 12.0 15.00 12 0.8 1.2500 NR 0 12 F/80 4 Pcom 9.5 10.50 7.5 0.71 1.1053 IR, neck preservation of fetal type pcom 0 13 M/42 4 Pcom 4.4 4.40 9 2.05 1.0000 IR, neck preservation of fetal type pcom 3 14 F/63 unruptured Pcom 3.3 4.20 4.3 1.02 1.2727 NR 0 15 F/67 2 Pcom 6.0 14.00 12 0.86 2.3333 IR, neck preservation of pcom 0 16 F/64 unruptured Acom 10.0 15.00 10 0.67 1.5000 IR, neck preservation of A2 0 17 M/48 unruptured Acom 9.0 12.00 10 0.83 1.3333 IR, neck preservation of A2 0 18 M/56 3 Acom 7.0 6.00 7 1.17 0.8571 complete 0 19 M/46 2 ICA dorsal 6.0 6.00 8 1.33 1.0000 complete 0 20 F/70 unruptured Cavernous 10.0 16.00 10 0.63 1.6000 DR 0 21 F/63 unruptured OA 13.0 24.00 24 1.6 1.8462 NR 0 22 F/60 unruptured OA 5.0 10.00 14 1.4 2.0000 IR, neck preservation of OA 0 23 M/38 unruptured SCA 5.0 3.50 5.3 1.51 0.7000 complete 0 24 F/55 unruptured SCA 5.0 8.00 5.5 0.69 1.6000 IR, neck preservation of SCA 0 25 M/38 2 MCAb 4.3 5.40 7.3 1.35 1.2558 complete 0 Note.—Acom indicates anterior communicating artery; D(H)/N ratio, dome(height)/neck ratio; DR, dome remnant; IR, intentional remnant; MCAb, middle cerebral artery bifurcation; mRS, modified Rankin Scale; NR, neck remnant; OA, ophthalmic artery; Pcom, posterior communicating artery; SAH (grade), subarachnoid hemorrhage (Hunt and Hess grade); SCA, superior cerebellar artery; and W/H ratio, width/height ratio.
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