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. 2008 Sep 1;14 Suppl 1(Suppl 1):63-74.
doi: 10.1177/15910199080140S112. Epub 2008 Oct 9.

Complications of interventional treatment of cerebral aneurysms

R Sellar  1
Affiliations

Complications of interventional treatment of cerebral aneurysms

R Sellar. Interv Neuroradiol. .
No abstract available

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Figures

Figure 1
Figure 1
A schematic outline of the clotting pathway and its interaction with platelets.. The site of action of the main antiplatelet and thrombolytic agents (adapted from R Laitt).
Figure 2
Figure 2
Clot forming on the coil ball (arrowhead).
Figure 3
Figure 3
A) shows an MCA aneurysm with vasospam of MI. B) shows complete occlusion of the internal carotid (arrow); no evidence of dissection seen. C) balloon angioplasty arrow and clot retrieval failed in this case. D) catheterisation via the left carotid was performed and shows multiple thrombi (arrowhead) in the distal ICA and occlusion of the MCA. E) The aneurysm is being rapidly coiled from the left carotid approach. F) Reopro was then given with rapid recannalisation, note the residual spasm in the M1 (arrow) and clot in the distal ICA. Nimopodine 1 mg was given IA and good perfusion of the MCA was achieved. The patient had no clinical deficit after the procedure.
Figure 4
Figure 4
Proximal vertebral occlusion (A) secondary to dissection (arrow) (B) following thrombolysis this reoccluded and required stenting (C) distal embolus (arrow) in an MCA branch, see delayed collateral flow in the image below.
Figure 5
Figure 5
Distal embolus (arrow) in an MCA branch, good collateral flow to the affected region. This was managed with fluids and hypertension with no resultantclinical deficit.
Figure 6
Figure 6
Loss of the right posterior cerebral artery (A), salvage angioplasty (B) coil ball remodelled (C) with artery reopened.
Figure 7
Figure 7
Distal coil embolisation (arrow). Distal coil embolisation; the coil is acting like a stent and not obstructing flow.
Figure 8
Figure 8
Coil migration (A) the long tail of coil can be stented to the artery wall or retrieved in this case by a goose necked snare (B),
Figure 9
Figure 9
A small helical coil arrowhead (A) being retrieved by a Merci device (B).
Figure 10
Figure 10
A small narrow necked aneurysm (A) in combination with the very tortuous proximal cerebral vessels (B) this is a high risk of rupture situation. The catheter tip is placed too close to the wall of the dome of the aneurysm. The coil and catheter in this situation often have stored energy (C) which over time releases into the aneurysm causing rupture (D)
Figure 11
Figure 11
There is a dissected right vertebral artery with two distict aneurysms (arrows) (A). Stenting followed by coiling the aneurysm has resulted in rupture (arrow) (B) Normally this would have been treated by parent vessel occlusion but the left subclavian was completely occluded.
Figure 12
Figure 12
Patient with a right cavernous carotid aneurysm with severe peri-orbital pain (A). The contra-lateral carotid angiogram performed whilst left carotid balloon inflated; no cross-flow across the anterior communicating artery noted. (B) Patient "passed" balloon occlusion test clinically but the small posterior communicating artery < 1.5 mm is worrying and a hypotensive challenge would have been useful. Patient had a stroke 12 hrs post occlusion. (c) A left vertebral injection shows filling of the right hemisphere arteries with no significant arterial or venous delay. Note that the posterior communicating artery is less that 1.5 mm in diameter.
See this image and copyright information in PMC

References

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