ABSTRACT
A patient presented with acute onset headache and subsequent unconsciousness. The neurologic exam showed left-sided myoclonic jerking and right flaccid hemiparalysis. Noncontrast computed tomography revealed diffuse subarachnoid hemorrhage (SAH) with acute hydrocephalus. Initial digital subtraction angiography (DSA) showed no culprit source for SAH. Repeat DSA on day 7 after initial presentation raised suspicion for left internal carotid artery ophthalmic segment and left lateral lenticulostriate artery (LSA) aneurysms. A magnetic resonance vessel wall imaging (VWI) exam was performed given the presence of multiple potential culprit aneurysms. Vessel wall enhancement around the dome of the left LSA aneurysm suggested rupture, which then facilitated treatment with surgical clipping. LSA aneurysms are exceedingly rare and challenging to treat. Given the associated high degree of morbidity, expedient diagnosis is critical to direct management. VWI could be a valuable tool for detecting ruptured aneurysms in the setting of angiogram-negative SAH.
ABSTRACT
Endovascular parent vessel sacrifice is an established technique used to treat vascular pathology and tumor infiltration of blood vessels. In high-flow vessels, such as the carotid artery or vertebral artery, distal coil migration and embolization are concerns. A method to mitigate this risk would improve the safety profile of the procedure. Five patients undergoing parent vessel sacrifice were retrospectively identified (from June 2018 to May 2019) for the purpose of illustrating this high-flow parent vessel occlusion technique. The technique utilizes a proximal dual-lumen balloon microcatheter inflated for blood flow arrest. The balloon-assisted, dual microcatheter technique is useful for occlusion of high-flow parent arteries. Because it utilizes both flow arrest and a tethered coil backstop, precise occlusion of a vessel can be achieved.
