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Endovascular Treatment:

 
  • Concerns: visual field defect in someone wanting to shoot a gun for a living.
  • Planned distal occlusion of PCA with prophylactic occipital-PCA bypass to reduce risk to visual pathway

  • Surgery #3: Failed bypass due to unfavorable anatomy (occipital artery too small).

 

Underwent successful GDC occlusion of outlet of the aneurysm -10/06/2002:

 

Note: Click to see enlarged images.


 

Over next 3 months:

 
  • Patient complains of recurrent transient episodes of homonymous hemianopia.
  • Cause?

 

Follow-Up:


Reconstitution of PCA through coil mass (!)

Date of Angiogram: 12/09/2002
Note: Click to play movies.


 

Question:


Now what?