Aneurysmal Subarachnoid Hemorrhage Trial RandOmizing Heparin: ASTROH Start Time of the Procedure: End time of the Procedure: Date: Name of Operator/Person Performing coiling procedure: Number of aneurysms identified on catheter angiography (circle the answer): 1 2 3 4 5 >5 Number of aneurysms treated with embolization (circle the answer): 1 2 3 4 5 >5 Largest size dimension of aneurysm (in mm): Aneurysm Volume (in mm3, as measured by angiocalc.com or similar): Location of the aneurysm (please be as specific as possible): Was Aneurysm #1 the source of hemorrhage? Definitely the source Likely the source Possibly the source Very Unlikely the source Definitely not the source What method of embolization was used? Primary Coiling Balloon-assisted Coiling Stent-Assisted Coiling Flow Diversion Intravascular or neck bridging device Liquid Embolism Parent Vessel Sacrifice
Aneurysmal Subarachnoid Hemorrhage Trial RandOmizing Heparin: ASTROH Start Time of the Procedure: End time of the Procedure: Date: Name of Operator/Person Performing coiling procedure: Number of aneurysms identified on catheter angiography (circle the answer): 1 2 3 4 5 >5 Number of aneurysms treated with embolization (circle the answer): 1 2 3 4 5 >5 Largest size dimension of aneurysm (in mm): Aneurysm Volume (in mm3, as measured by angiocalc.com or similar): Location of the aneurysm (please be as specific as possible): Was Aneurysm #1 the source of hemorrhage? Definitely the source Likely the source Possibly the source Very Unlikely the source Definitely not the source What method of embolization was used? Primary Coiling Balloon-assisted Coiling Stent-Assisted Coiling Flow Diversion Intravascular or neck bridging device Liquid Embolism Parent Vessel Sacrifice
astroh_procedure_questionnaire.docx