STENT REMODELING TECHNIQUE FOR COILING OF RUPTURED WIDE-NECK CEREBRAL ANEURYSMS: CASE REPORT

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. E1007-E1008 ◽  
Author(s):  
Demetrius K. Lopes ◽  
Kalani Wells
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Acute Subarachnoid Hemorrhage ◽  
The Right ◽  
Wide Neck ◽  
Cordis Corporation

Abstract OBJECTIVE To describe a novel stent remodeling technique for the coiling of ruptured wide-neck cerebral aneurysms. CLINICAL PRESENTATION A 46-year-old man presented with acute subarachnoid hemorrhage (Hunt and Hess grade IV), intracerebral hemorrhage, and hydrocephalus. Cerebral angiography revealed a wide-neck small anterior communicating artery aneurysm. Conventional coiling was not successful because of coil instability and compromise of the dominant anterior cerebral artery. TECHNIQUE A 6-French shuttle sheath (Cook Medical, Indianapolis, IN) was advanced from a right femoral approach into the right common carotid artery. To protect the parent vessel during coiling without compromising blood flow, a Prowler Select Plus catheter (Cordis Corporation, Bridgewater, NJ) was navigated across the aneurysm neck. Subsequently, an Enterprise stent (22-mm length; Cordis Corporation) was partially deployed across the aneurysm's wide neck. It was very important to watch the distal markers of the stent and lock the stent delivery wire to the Prowler Select Plus with a hemostatic valve once the stent was halfway deployed. This maneuver was essential to prevent further deployment of the stent. The SL-10 microcatheter and Synchro 14 wire (Boston Scientific, Natick, MA) were carefully navigated to the aneurysm passing through the partially deployed stent. Coils were then delivered to the aneurysm using the stent as a scaffold. After coiling, the SL-10 microcatheter was removed and the stent was recaptured into the Prowler Select Plus catheter. During the recapture, there was initial resistance. This was easily overcome after deploying the stent a little more before resheathing. During the procedure, the patient received 2000 U of heparin after the first coil was detached in the aneurysm. CONCLUSION The stent remodeling technique is a novel endovascular technique that can be used to treat ruptured wide-neck aneurysms and maintain patency of parent vessels, avoiding the use of antiplatelet therapy in acute subarachnoid hemorrhage.

Acute Spinal Epidural Hematoma and Cranial Interdural Hematoma Due to a Rupture of a Posterior Communicating Artery Aneurysm: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. E1000-E1004 ◽  
Author(s):  
Andrea Bartoli ◽  
Marc Kotowski ◽  
Vitor Mendes Pereira ◽  
Karl Schaller
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Epidural Hematoma ◽  
Clinical Presentation ◽  
Artery Aneurysm ◽  
Posterior Communicating Artery ◽  
Spinal Epidural Hematoma ◽  
Anterior Communicating Artery ◽  
Posterior Communicating Artery Aneurysm ◽  
The Right ◽  
Spinal Epidural

Abstract BACKGROUND AND IMPORTANCE: We describe an unusual presentation of a ruptured aneurysm of the posterior communicating artery with an acute intracranial hematoma between the dural layers associated with an acute spinal epidural hematoma descending to L1. CLINICAL PRESENTATION: A 35-year-old woman presented 3 hours after ictus with a postcoital headache, neck stiffness, and bilateral abducens cranial nerve palsy. No other neurological deficits were present. Clinically, she had a subarachnoid hemorrhage World Federation of Neurosurgical Societies grade 1. CT scan demonstrates an acute subdural hematoma, extending from the right parasellar region, around the clivus, tentorium, and falx. Angio-CT showed a posterior communicating artery aneurysm and an anterior communicating artery aneurysm and an extension of the hematoma to the cervical spine. This justified a spinal and cerebral MRI that confirmed an extension of the hematoma to the epidural space at the cervical, thoracic, and lumbar levels. Three-dimensional digital subtraction angiography confirmed aneurysms on the right posterior communicating artery and on the anterior communicating artery. Both aneurysms were completely occluded by coiling. With reference to the concept of the cranial subdural compartment described in studies conducted using an electron microscope, this group of hematomas was classified as interdural. CONCLUSION: Ruptured aneurysm of the posterior communicating artery may cause cranial acute interdural hematoma with a typical subarachnoid hemorrhage clinical presentation, and it rarely can extend to spinal epidural space.

scholarly journals Fenestration of the Supraclinoid Internal Carotid Artery

1987 ◽  
Vol 14 (2) ◽  
pp. 159-161 ◽  
Author(s):  
J. Max Findlay ◽  
Mario Chui ◽  
Paul J. Muller
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Accessory Middle Cerebral Artery ◽  
The Right ◽  
Supraclinoid Internal Carotid Artery

Abstract:A twenty-eight year old woman presenting with subarachnoid hemorrhage was found at angiography to have a left anterior cerebral-anterior communicating artery aneurysm. Also identified was a fenestration of the right supraclinoid internal carotid artery with an associated accessory middle cerebral artery. This appears to be the second reported case of fenestration of the intracranial internal carotid artery. Fenestrations of cerebral vessels and their possible embryologic origins are briefly reviewed.

scholarly journals Nautilus-assisted coil embolization for a complex AcomA wide-necked aneurysm in the setting of acute subarachnoid hemorrhage

2021 ◽  
pp. neurintsurg-2021-017670
Author(s):  
Alexander Sirakov ◽  
Svetozar Matanov ◽  
Pervinder Bhogal ◽  
Stanimir Sirakov
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Anterior Communicating Artery ◽  
New Approach ◽  
Content Type ◽  
Acute Subarachnoid Hemorrhage ◽  
Inner Diameter ◽  
Aneurysmal Neck ◽  
Video Player

Numerous devices and sophisticated strategies have been developed to further increase the number of aneurysms amenable to endovascular treatment.1–4 Despite the superfluity of available neurovascular armamentarium, wide-necked bifurcation aneurysms can still pose a significant technical challenge to the treating clinician.5–7 Neck bridging is a conceptually new approach, which provides increased occlusion rates with lower recurrence and complications rates.8–10 The Nautilus (EndoStream Medical) is an intrasaccular bridging device intended to assist in coil embolization of wide-necked cerebral aneurysms. This CE-marked device, available in various sizes, consists of flexible-layers, and is a nitinol-based, detachable implant. The device is delivered through a standard microcatheter with a minimal 0.0165" inner diameter and is fully radiopaque and completely resheathable.Owing to its unique ‘tornado’ like shape the device entirely reconstructs the aneurysmal neck, which facilitates the following coil embolization. In this video 1, we demonstrate the use of Nautilus - assisted coil embolization for a complex anterior communicating artery (AcomA) wide-necked aneurysm in the setting of acute subarachnoid hemorrhage.Video 1

scholarly journals Spontaneous Disappearance of an Intracranial Aneurysm After Subarachnoid Hemorrhage

1992 ◽  
Vol 19 (3) ◽  
pp. 389-391 ◽  
Author(s):  
Mark G. Hamilton ◽  
Oliver N.R. Dold
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Complete Disappearance ◽  
Slow Recovery ◽  
Spontaneous Thrombosis ◽  
Grade 5 ◽  
Spontaneous Disappearance

ABSTRACT:Spontaneous disappearance of an intracranial aneurysm after subarachnoid hemorrhage is an uncommon event and usually associated with severe cerebral vasospasm, giant aneurysms or the use of antifibrinolytics. We present a young woman who suffered a grade 5 subarachnoid hemorrhage with severe vasospasm caused by a small anterior communicating artery aneurysm. The patient underwent a slow recovery and two years later requested surgery. Angiography demonstrated complete disappearance of the aneurysm. The neurosurgeon should be aware that spontaneous thrombosis of cerebral aneurysms can occur and ensure that angiography is repeated when surgery is significantly delayed.

Microcatheter Neck Bridging and Incorporated Branch Vessel Protection for Coil Embolization of a Wide-Neck Ruptured Aneurysm: Technical Case Report

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons40-ons44 ◽  
Author(s):  
Ajeet Gordhan
Keyword(s):  
Artery Aneurysm ◽  
Posterior Communicating Artery ◽  
Endovascular Coiling ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Guglielmi Detachable Coil ◽  
Fisher Grade ◽  
Branch Vessel ◽  
Posterior Communicating Artery Aneurysm ◽  
Wide Neck

Abstract BACKGROUND AND IMPORTANCE: A novel technique in which microcatheter neck bridging of a ruptured wide-neck posterior communicating artery aneurysm was performed by intra-aneurysmal catheter navigation into a fetal configuration posterior cerebral artery (PCA) branch vessel arising from the sac. CLINICAL PRESENTATION: An 88-year-old woman with a Hunt and Hess grade 1 and Fisher grade 4 subarachnoid hemorrhage was identified as having a wide-neck posterior communicating artery aneurysm and an isolated fetal configuration PCA with origins from the aneurysm sac. Delivery of a bare platinum Guglielmi detachable coil within the aneurysm lumen resulted in persistent coil prolapse into the parent vessel with occlusion of the incorporated vital PCA origin. A microcatheter was then navigated through the aneurysm lumen and into the fetal configuration PCA. This was retained within the PCA with resultant aneurysm neck narrowing and branch vessel protection. A second microcatheter was placed in the aneurysm lumen for coil delivery. Complete aneurysm occlusion with patency of the PCA without coil loop prolapse into the parent vessel was achieved. CONCLUSION: The presence of normal branch vessels arising from the dome is a limitation for endovascular techniques. To the best of our knowledge, no prior description of a dual-microcatheter technique with selective catheter placement within an important intra-aneurysmal branch vessel has been published. The vital branch vessel was protected and the wide-neck aneurysm completely occluded. Novel placement of microcatheters further expands the range of complex configuration aneurysms amenable to endovascular coiling.

Transvascular Coil Hooking Procedure to Retrieve an Unraveled Guglielmi Detachable Coil: Technical Note

Neurosurgery ◽  
2002 ◽  
Vol 50 (4) ◽  
pp. 912-915 ◽  
Author(s):  
Christian Raftopoulos ◽  
Pierre Goffette ◽  
Rudolf F. Billa ◽  
Pierre Mathurin
Keyword(s):  
Cerebral Artery ◽  
Rare Complication ◽  
Artery Aneurysm ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Left Middle Cerebral Artery ◽  
Parent Vessel ◽  
Detachable Coil ◽  
Aneurysm Neck ◽  
Guglielmi Detachable Coil

Abstract OBJECTIVE: A patient with an anterior communicating artery aneurysm was treated by use of endovascular coiling, and a Guglielmi detachable coil (Boston Scientific/Target, Fremont, CA) fractured distal to its connection to the delivering catheter. The unraveled coil floated out from the aneurysm to extend into the bifurcation of the left middle cerebral artery. We describe the microsurgical procedure used to retrieve the coil after an endovascular approach failed. METHODS: The left anterior cerebral artery was punctured just below the aneurysm neck, and a titanium microhook was introduced to anchor the coil and pull it out. Slight traction was exerted before sectioning the coil to avoid protrusion of the stump into the parent vessel. RESULTS: The unraveled coil was removed in totality without permanent morbidity. CONCLUSION: This report describes the case of a rare complication of coil embolization treated with a minimal transarterial coil hooking procedure.

scholarly journals Anterior Communicating Artery Aneurysm Treatment with the Pipeline Embolization Device: A Single-Center Experience with Long-Term Follow-Up

2017 ◽  
Vol 6 (3-4) ◽  
pp. 126-134 ◽  
Author(s):  
Ali Sultan-Qurraie ◽  
Ahsan Sattar ◽  
Wled Wazni ◽  
Mazen Noufal ◽  
Osama Zaidat
Keyword(s):  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Parent Artery ◽  
Data Set ◽  
Pipeline Embolization Device ◽  
Aneurysm Neck ◽  
Single Center Experience

Introduction: The pipeline embolization device (PED) is increasingly used in the endovascular management of cerebral aneurysms. Longitudinal data regarding safety and benefit of the PED in anterior communicating (ACOM) artery aneurysms are limited and particularly lacking in residual ACOM artery aneurysms. We report the use of the PED in 3 patients with ACOM artery aneurysms who were previously coiled. Methods: Three patients with ACOM artery aneurysms, all previously treated with coiling and with recurrence of the aneurysm neck, were treated with the PED. All obtained follow-up diagnostic cerebral angiograms at either 3 or 6 months. Results: Mean age of patients was 59 years. All patients received cerebral angiograms at a minimum of 3 months after treatment with the PED. Follow-up angiography was performed up to a mean of 10 months at which time point all cases demonstrated complete aneurysm occlusion, without any stenosis in the parent artery. Conclusion: The PED can be safely used for the treatment of ACOM artery aneurysms. Complete aneurysm obliteration can be achieved in cases refractory to endovascular coiling. These findings warrant replication in a larger data set.

Thrombolysis and Mechanical Fragmentation to Treat Massive Pulmonary Embolism in a Patient with an Anterior Communicating Artery Aneurysm

2003 ◽  
Vol 10 (2) ◽  
pp. 332-335 ◽  
Author(s):  
Ramazan Kutlu ◽  
Alpay Alkan ◽  
Ayhan Kocak ◽  
Kaya Sarac
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Arteries ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Recombinant Tissue Plasminogen Activator ◽  
Massive Pulmonary Embolism ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysm ◽  
The Right ◽  
Mechanical Fragmentation

Purpose: To describe successful management of massive pulmonary embolism suffered by a patient with an unsecured intracranial aneurysm. Case Report: An anterior communicating artery aneurysm was found 10 days after a 50-year-old woman was admitted to the intensive care unit with subarachnoid hemorrhage. The patient developed severe acute dyspnea before planned surgery; imaging demonstrated thrombus in the right and left pulmonary arteries. Heparin was contraindicated, so an emergent coil embolization procedure was undertaken. In the same session, recombinant tissue plasminogen activator was administered directly into the thrombus. After 2 hours of thrombolysis and intermittent mechanical fragmentation, lung perfusion improved, and the patient's symptoms abated. Conclusions: Mechanical fragmentation together with fibrinolytic agent administration is a safe and effective treatment for pulmonary embolism after securing cerebral aneurysms.

Multiple ruptured cerebral aneurysms in a child with Takayasu arteritis

2008 ◽  
Vol 1 (1) ◽  
pp. 83-87 ◽  
Author(s):  
Suresh N. Magge ◽  
H. Isaac Chen ◽  
Michael F. Stiefel ◽  
Linda Ernst ◽  
Ann Marie Cahill ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysm ◽  
Takayasu Arteritis ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Rare Presentation ◽  
Anterior Communicating Artery Aneurysm ◽  
Clip Application

✓The authors report the case of an 18-month-old girl who presented with a ruptured anterior communicating artery aneurysm, and who was later diagnosed with Takayasu arteritis. Her initial aneurysm was successfully treated with clip application. However, over a 6-month period she had multiple ruptures from new and rapidly recurring aneurysms adjacent to the clips. These aneurysms were treated with repeated craniotomy and clip application and then with endovascular coil placement. Aneurysmal subarachnoid hemorrhage is a rare presentation of Takayasu arteritis. To the authors' knowledge, this is the youngest reported patient with Takayasu arteritis to present with a ruptured cerebral aneurysm.

scholarly journals Re-treatment of an unruptured anterior communicating artery aneurysm using the new pCONus 2 device: Description of a case

2018 ◽  
Vol 24 (4) ◽  
pp. 379-382
Author(s):  
Marco Varrassi ◽  
Sergio Carducci ◽  
Aldo V Giordano ◽  
Carlo Masciocchi
Keyword(s):  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Longitudinal Axis ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Anterior Communicating Artery Aneurysm ◽  
First Case ◽  
Endovascular Approach ◽  
Unruptured Cerebral Aneurysms ◽  
Aneurysmal Neck

Endovascular approach represents today the first option in treatment of ruptured and unruptured cerebral aneurysms. Nevertheless, wide-neck bifurcation aneurysms still represent a technical challenge for endovascular treatment due to the need to protect vessels arising next to the aneurysmal neck. A variety of devices have been implemented to ensure adequate assistance for coiling of these lesions. Among these devices, the new pCONus 2 represents an evolution of the well-known pCONus; compared to the previous one in fact, it allows a degree of articulation and flexibility between the shaft and the distal part (crown), making it more suitable for treatment of aneurysms presenting an angle between the longitudinal axis of the dome and parent vessel. We report our first case using pCONus 2 in the re-treatment of an unruptured anterior communicating artery aneurysm in a 57-year-old man, showing evident recanalization two years after coiling.

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