Question

DIAGNOSIS: Cerebral aneurysm

PROCEDURES PERFORMED: Transarterial embolization of large right internal carotid artery aneurysm by aneurysm exclusion from the parent artery using pipeline embolization device.
After obtaining a groin access the right common carotid artery was selectively catheterized over
0.035 Glidewire. Images were obtained in standard AP and lateral projection. Evidence of intracranial aneurysm was noted.
The right internal carotid artery was selectively catheterized under fluoroscopy guidance and roadmap images of Sofia catheter which was advanced over 0.035 Glidewire. Images were obtained in standard AP and lateral projections. The cervical segment of the right internal carotid artery was noted and appears unremarkable. Paraophthalmic artery aneurysm was noted pointing inferiorly measuring 5.5 × 4.5 mm. Aneurysm neck measures around 3.8 mm. A pipeline embolization device 5 × 25 was prepped in the standard fashion and advanced under fluoroscopy guidance and roadmap images into the right middle cerebral artery. Pipeline embolization was then unsheathed in the middle cerebral artery and pulled back to the bifurcating segment of the right internal carotid artery. The stent was then successfully deployed extending from the bifurcating segment distally to the cavernous segment proximally. Balloon angioplasty was then performed with scepter XC 4 × 11. Excellent position was achieved distally. Multiple follow-up angiograms × 6 were performed for evaluation of the deployment of the stent and following the balloon angioplasty, revealing good pipeline embolization device deployment. Desired contrast stagnation was noted at the intracranial aneurysm. The catheter was removed in the standard fashion. Hemostasis was maintained and arteriotomy was closed using an 8 French Angio-Seal closure device and manual pressure.
Impression: Paraophthalmic intracranial artery aneurysm was noted pointing inferiorly measuring 5.5 × 4.5 mm. Aneurysm neck measures around 3.8 mm.

Answer 1

Diagnosis: Cerebral aneurysm; Procedure: Transarterial embolization of a large right internal carotid artery aneurysm using a pipeline embolization device, with successful deployment and angioplasty.

The patient's diagnosis is a cerebral aneurysm, specifically a paraophthalmic intracranial artery aneurysm measuring 5.5 × 4.5 mm with a neck size of approximately 3.8 mm. The performed procedure was a transarterial embolization of the large right internal carotid artery aneurysm using a pipeline embolization device.

The intervention involved accessing the right common carotid artery through the groin, catheterizing the right internal carotid artery under fluoroscopy guidance, and deploying a pipeline embolization device from the bifurcating segment distally to the cavernous segment proximally. Balloon angioplasty with a scepter XC 4 × 11 was conducted to achieve excellent positioning, and multiple follow-up angiograms confirmed the successful deployment of the stent and revealed desired contrast stagnation at the intracranial aneurysm.

The procedure concluded with the closure of the arteriotomy using an 8 French Angio-Seal closure device and manual pressure, ensuring hemostasis. Overall, the intervention aimed at excluding the aneurysm from the parent artery, preventing potential complications associated with the aneurysm's rupture or expansion.