PMC9610440_01
Head computed tomography (CT) at first onset of intracerebral hemorrhage. A hematoma 7 cm in size was found in the right parietal lobe in axial (a) and coronal (b) view.
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The hematoma was removed by craniotomy in the neurosurgery department of another hospital (day 0) [Figure 1].
(a) Head CT showed subarachnoid hemorrhage. (b) Three-dimensional reconstruction of CT angiography showed aneurysm in the P4 segment of the left posterior cerebral artery.
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Three days later (day 54), the patient developed subarachnoid hemorrhage and was referred to our department [Figure 2a]. Cerebral angiography showed an aneurysm in the P4 segment of the left posterior cerebral artery (PCA) [Figure 2b], and endovascular parent artery occlusion was performed with a coil on the same day.
Endovascular parent artery occlusion, (a) A microcatheter (Lester STR 1.7-2.3Fr 157 cm) was guided to the distal neck of the aneurysm. (b) A total of 12 coils were filled with sequential backfilling. (c) The aneurysm was no longer depicted after occlusion of the parent artery.
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Aichi, Japan) was inserted into the left vertebral artery through the left brachial artery. A microcatheter (1.7Fr RESTAR, Medico's Hirata, Osaka, Japan) was guided to the distal part of the aneurysm neck using a 3.2Fr TACTICS (Technocrat, Aichi, Japan) as the distal access catheter [Figure 3a] and filled with a total of 12 coils in a sequential refilling fashion to complete the procedure [Figures 3b and c].
Time course of head CT scan after endovascular parent artery occlusion. On postoperative day 3 (day 57), head CT showed left temporal lobe subcortical hemorrhage (a) on day 85, head contrast-enhanced CT showed multiple microaneurysms (arrow heads) (b) on day 92, head CT showed left putamen hemorrhage with cerebral herniation (c).
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On the 3rd postoperative day (day 57), head CT showed asymptomatic subcortical hemorrhage in the left temporal lobe [Figure 4a]. Contrast-enhanced CT 1 month after the operation (day 85) showed multiple diffuse microaneurysms [Figure 4b]. One week later (day 92), a massive intracerebral hemorrhage in the left putamen resulted in cerebral herniation and the patient died [Figure 4c].