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Stent-Assisted Coil Embolization

Right paraophthalmic artery aneurysm treated by Dr. Monica Pearl

Intracranial aneurysms are estimated to occur in approximately 2% of the general population. A number of different endovascular and surgical options are available for their treatment. Choosing the best management depends on many factors including the size, shape and location of the aneurysm. Another consideration is whether or not the aneurysm has ruptured.

This patient had a right paraophthalmic (near the artery that branches to the eye) artery aneurysm that continued to increase in size after it was diagnosed.

 3D reconstruction of a paraophthalmic aneurysm. The arteries are shown in red on a black background.
Figure 1. 3D reconstruction of a paraophthalmic aneurysm

Figure 1 is a 3D digital subtraction angiography (DSA) reconstruction. The image was obtained during a diagnostic cerebral angiogram. It shows the arteries of the right side of the brain viewed from the front. This type of image helps doctors study important features of blood vessels such as the size and shape of aneurysms. The aneurysm is seen as an outpouching or bulge on the vessel.

This patient underwent successful stent-assisted coil embolization and returned home in two days after the procedure. The procedure is shown in Figure 2.

An illustration showing stent-assisted coil embolization in four images. 1. A stent is placed across the aneurysm. 2. A catheter is placed in the aneurysm. 3. Coils are put into the aneurysm through the catheter. 4. the coils stay inside of the aneurysm because the still keeps them inside.
Figure 2. Stent-assisted coil embolization

Stent-assisted coiling before and after. The aneurysm is no longer visible because blood is no longer enteriing it.
Figure 3. Arteries of the right side of the brain viewed from the front before and after stent-assisted coil embolization.

Figure 3 shows images of the arteries of the right side of the brain viewed from the front of the same patient in Figure 2. The image on the left is from the diagnostic cerebral angiogram recorded before stent-assisted coiling. The image on the right shows the same view after stent-assisted coiling. The aneurysm has been completely filled with coils and is no longer visible. The main vessel from which the aneurysm grew (the internal carotid artery) remains open so that it can supply blood to the brain. Follow-up MRI/MRA at one year after this procedure showed no recurrence of the aneurysm.

Publication:
Endovascular treatment of aneurysmal subarachnoid hemorrhage. Pearl M, Gregg L, Gailloud P. Neurosurg Clin N Am. 2010 Apr;21(2):271-80. Review.

 

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