Rescue embolization with direct coil delivery from dual-lumen balloon microcatheter

2021 ◽  
pp. 159101992110609
Author(s):  
Ching-Chang Chen ◽  
Chun-Ting Chen ◽  
Po-Chuan Hsieh ◽  
Mun-Chun Yeap ◽  
Yi-Ming Wu
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Coil Embolization ◽  
Balloon Catheter ◽  
Dissecting Aneurysm ◽  
Inflated Balloon ◽  
Emergency Situations ◽  
Acute Infarction ◽  
Stent Retrieval ◽  
Vertebral Artery Dissecting Aneurysm

Background Balloon microcatheters are widely used for endovascular treatment. However, no reports on direct coil embolization from dual-lumen balloon microcatheters are available in the literature. This report is the first description of direct coil embolization using this type of balloon microcatheter for looming bleeding emergencies. Methods This retrospective review demonstrates the indications and advantages of coil embolization from an inflated balloon catheter to reduce blood loss and simultaneously occlude bleeding. Results Five patients who underwent emergency endovascular treatment using coil embolization directly delivered from a dual-lumen balloon were identified. Etiologies included vertebro-vertebral arteriovenous fistula, ruptured vertebral artery dissecting aneurysm, vertebral artery injury during cervical spinal operation, and failed stent retrieval procedures for acute infarction. Complete hemostasis was achieved with all procedures. Conclusion Our experience demonstrates the feasibility of direct coil embolization by using a dual-lumen balloon to rapidly halt bleeding in some rare emergency situations, which may save lives.

scholarly journals Stent-assisted coil embolization of unruptured vertebral artery dissecting aneurysms with the low-profile visualized intraluminal support stent, with five techniques: Technical note and case report

2019 ◽  
Vol 10 ◽  
pp. 105
Author(s):  
Ryosuke Maeoka ◽  
Ichiro Nakagawa ◽  
Koji Omoto ◽  
Takeshi Wada ◽  
Kimihiko Kichikawa ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Coil Embolization ◽  
Posterior Inferior Cerebellar Artery ◽  
Dissecting Aneurysm ◽  
Parent Artery ◽  
High Morbidity ◽  
Low Profile ◽  
Ischemic Complications ◽  
Wall Apposition ◽  
Vertebral Artery Dissecting Aneurysm

Background: Intracranial vertebral artery dissecting aneurysm (VADA) is rare and shows high morbidity and mortality rates when the aneurysm ruptures. Endovascular treatment for VADA is one of the optimal treatments, but the dominant side VA and its branches or perforators need to be preserved. We report a novel and successful stent-assisted coil embolization technique using the low-profile visualized intraluminal support (LVIS) stent, with five technical notes in three consecutive cases of unruptured vertebral artery dissecting aneurysm (VADA). Case Description: We report three consecutive cases of unruptured VADA which involved a posterior inferior cerebellar artery (PICA), an anterior spinal artery, and perforators. Stent-assisted coil embolization with the LVIS stent was performed in all patients. The stent was carefully placed to obtain parent artery wall apposition at distal portion and with moderate pushing at aneurysm portion. The LVIS stent was placed with tailor-made wall apposition at perforating arterial side in the barrel view, and coil embolization was performed avoiding doughnut-like stent form to prevent perforator infarcts. All cases showed complete occlusion of the aneurysms with preservation of both parent artery and its branches and perforators patency. In three cases, clinical presentations were improved without ischemic complications. The median follow-up period was 1 year. At present, no recurrence and no complication have been observed. Conclusion: We demonstrate the coil embolization of VADA using LVIS stent with five techniques. Our techniques for the treatment of VADA using LVIS stent are safe and can minimize ischemic complications by creating suitable wall apposition to the orifices of branches or perforators.

scholarly journals Endovascular Treatment of Ruptured Vertebral Artery Dissecting Aneurysm in Fibromuscular Dysplasia

2019 ◽  
Vol 38 (02) ◽  
pp. 149-152
Author(s):  
Luana Antunes Maranha Gatto ◽  
Diego do Monte Rodrigues Seabra ◽  
Jennyfer Paulla Galdino Chaves ◽  
Gelson Luis Koppe ◽  
Zeferino Demartini
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Fibromuscular Dysplasia ◽  
Imaging Techniques ◽  
Dissecting Aneurysm ◽  
Renal Arteries ◽  
Good Outcome ◽  
Vertebral Artery Dissecting Aneurysm

Background Fibromuscular dysplasia (FMD) affects predominantly the cervical and renal arteries and may cause the classical angiographic pattern of string-of-beads. The diagnosis is increasing with the advances of imaging techniques. Case Report A 37-year-old man presenting with subarachnoid hemorrhage due to a dissecting aneurysm of the vertebral artery was treated by angioplasty with stent, with good outcome. All of the cervical and renal arteries were diseased and showed dysplasia and/or ectasias. Conclusions There are no guidelines or protocols to treat patients with FMD.

scholarly journals Endovascular reconstructive treatment using a fill-and-tunnel technique for a fusiform vertebral artery dissecting aneurysm with ipsilateral dominance

2019 ◽  
Vol 25 (5) ◽  
pp. 539-547
Author(s):  
Jun Kyeung Ko ◽  
Sang Weon Lee ◽  
Chang Hwa Choi ◽  
Tae Hong Lee
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Dissecting Aneurysm ◽  
Maximum Diameter ◽  
Parent Artery ◽  
Complete Occlusion ◽  
Average Maximum ◽  
Tunnel Technique ◽  
Vertebral Artery Dissecting Aneurysm ◽  
Dissecting Aneurysms

Background Fusiform dissecting aneurysms involving the dominant vertebral artery with poor collaterals are challenging to treat. The purpose of this study was to present an initial experience with a fill and tunnel technique for reconstructive endovascular treatment of these conditions. Methods A total of 13 patients, 11 men and 2 women, each with a fusiform vertebral artery dissecting aneurysm not amenable to internal trapping of the parent artery, underwent reconstructive endovascular treatment using a fill and tunnel technique between January 2012 and December 2015. The safety, feasibility, and clinical and angiographic outcomes of these procedures were retrospectively evaluated. Results The average maximum diameter of the fusiform aneurysms was 12.1 mm. Five were ruptured. Three aneurysms were treated with a single stent and the remaining 10 aneurysms required double-stent placement. Treatment was technically successful in all 13 patients, achieving complete occlusion ( n = 10, 76.9%) and near-complete occlusion ( n = 3, 23.1%). No procedure-related complications occurred in any patient. There were no delayed thromboembolic or hemorrhagic complications during the follow-up period (mean, 19.0 months). Angiographic follow-ups (mean, 9.1 months) showed stable occlusion in 90.9% (10/11) and asymptomatic in-stent occlusion in one patient (9.1%, 1/11). At the end of the observation period (mean, 19.0 months), all patients had excellent clinical outcomes (modified Rankin Scale (mRS) 0, 92.3%, 12/13), except one (mRS 4), resulting from poor preoperative status. Conclusions This retrospective study demonstrated that endovascular reconstruction using a fill-and-tunnel technique was a technically safe, feasible, and clinically effective treatment method for fusiform vertebral artery dissecting aneurysms with ipsilateral dominance.

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