PMC3800601_01
Oblique CTA scans demonstrating an ectatic fusiform dilatation of the involved MCA distal branch with aneurysm, in addition to saccular smaller aneurysm at the origin of MCA bifurcation.
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A subsequent brain CT scan, on the 5th SAH day, was negative for SAH but 3D-CT angiogram revealed one large distal fusiform and another 2 smaller aneurysms: one at the right MCA and another at the right PCA (Figures 1 and 2).
Lateral CTA scans demonstrating an ectatic fusiform dilatation of the involved MCA distal branch with aneurysm. In addition, a saccular smaller aneurysm at the origin of MCA bifurcation and another fusiform smaller aneurysm at the first segment of PCA were demonstrated.
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A subsequent brain CT scan, on the 5th SAH day, was negative for SAH but 3D-CT angiogram revealed one large distal fusiform and another 2 smaller aneurysms: one at the right MCA and another at the right PCA (Figures 1 and 2).
Anterior-posterior view of cerebral angiographic (DSA) image demonstrating an 8 mm right M3-MCA fusiform aneurysm and a 4 mm M2-MCA saccular aneurysm.
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A conventional four-vessel cerebral angiogram (DSA) revealed an ectatic fusiform dilatation of insular M3-segment of the right MCA with 4 mm proximal (M2-segment) aneurysm and 8 mm distal (M3-segment) fusiform aneurysms (Figures 3 and 4).
Lateral view of cerebral angiographic (DSA) image demonstrating an 8 mm right M3-MCA fusiform aneurysm with disease ectatic parent artery.
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A conventional four-vessel cerebral angiogram (DSA) revealed an ectatic fusiform dilatation of insular M3-segment of the right MCA with 4 mm proximal (M2-segment) aneurysm and 8 mm distal (M3-segment) fusiform aneurysms (Figures 3 and 4).
Intraprocedure cerebral angiogram demonstrating microcatheter tip placement within the fusiform aneurysm and Onyx embolization completion.
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Onyx 18 was injected slowly into the aneurysm with slow lamination of the precipitated amount within the aneurysm (Figure 5).
MRI-GE image scan 24 hours after Onyx embolization showing an area of low intensity at the site of embolic material within the aneurysm without ischemic complication.
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An area of low intensity at the site of embolic material has been revealed with resolution of the ruptured MCA aneurysm (Figure 6).
24-hour post-Onyx embolization MRA scan in AP view demonstrating resolution of the embolized MCA aneurysm.
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Furthermore, there was no evidence of any ischemic insult (Figure 7).
Cerebral angiographic (DSA) image in AP view of right ICA at 6-month follow-up, demonstrating complete obliteration of the embolized aneurysm with retrograde filling of the normal artery distal to the aneurysm. The smaller aneurysm has shown significant reduction in size.
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Cerebral angiographic (DSA) image in lateral view of right ICA at 6-month follow-up, demonstrating complete obliteration of the embolized aneurysm with retrograde filling of the normal artery distal to the aneurysm.
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