PMC8571254_01
Non-contrast CT demonstrates a left-side frontoparietal intraparenchymal hemorrhage with associated subarachnoid hemorrhage.
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F1
Subsequently, he underwent a computed tomography (CT) scan of the brain, which depicted a massive left-side frontoparietal intracerebral hematoma with associated subarachnoid hemorrhage [Figure 1].
Lateral angiogram showing pseudoaneurysm of the left callosomarginal artery.
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F2
In particular, digital subtraction angiography (DSA) (4-vessel study) was performed, which revealed a fusiform aneurysmal dilatation in the left pericallosal artery, a distal segment of anterior cerebral artery [Figure 2]. It also revealed delayed contrast medium filling and emptying without a clear aneurysmal neck, typical characteristics of pseudoaneurysms.
Postembolisation lateral global angiogram showing complete occlusion of the pseudoaneurysmand the segment of the callosomarginal artery prior to the pseudoaneurysm using coils and Onyx18.
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F3
Onyx18 (cv3, Irvine, CA, USA) was performed to occlude the distal part of the callosomarginal artery [Figure 3].
Lateral angiogram showing pseudoaneurysm of the M2 branch (superior division) of the right middle cerebral artery.
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F4
Twenty-two months later, the patient was readmitted with the same clinical presentation, and the DSA demonstrated a second IAP in the frontoparietal branch of the right middle cerebral artery in the M2 segment [Figure 4]. On the same day of the admission, the decision was to emergently proceed to endovascular repair. The aim of the endovascular approach was to occlude the pseudoaneurysm as well as the parent artery using coils and glue (Glubran 2/Lipiodol).
Postembolisation lateral global angiogram showing embolization of the pseudoaneurysm and occlusion of the segment of the M2 artery prior to the pseudoaneurysm.
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F5
Complete embolization of the second pseudoaneurysm was achieved following the same endovascular technique [Figure 5].