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.

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.

Reduction of Intra-Aneurysmal Kinetic Energy by Intralumenal Flow Diverting Devices

2007 ◽  
Author(s):  
Jaehoon Seong ◽  
Baruch B. Lieber ◽  
Ajay K. Wakhloo
Keyword(s):  
Conclusive Evidence ◽  
Endovascular Coiling ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Custom Made ◽  
Aneurysm Occlusion ◽  
Flow Activity ◽  
Wide Neck

Endovascular coiling is an acceptable treatment of intracranial aneurysms yet long term follow-ups suggest that endovascular coiling fails to achieve complete aneurysm occlusion particularly in wide-neck and giant aneurysms. Flow diverting devices can serve as an alternative to coils in endovascular bypass of human brain aneurysms for their exclusion from the cerebral circulation. They can redirect flow away from the aneurysm distally into the parent vessel thereby reestablishing physiological flow patterns. Placing of a flow diverting device across the aneurysm neck may be sufficient to occlude the aneurysm by promoting intra-aneurysmal thrombosis, however, conclusive evidence of its efficacy are still lacking. In this study [1], we investigated in vitro the efficacy of custom designed flow diverting devices and develop indices of their performance in an elastomeric model of the elastase-induced aneurysm in rabbit. The efficacy of custom designed flow divertors is investigated in terms of reducing the flow activity inside the sac. These custom made devices possess porosities that are similar to available stents, however, their pore densities are much higher. The results will help optimize the device that will be used in the animal model.

Outcome of Oculomotor Nerve Palsy from Posterior Communicating Artery Aneurysms: Comparison of Clipping and Coiling

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1040-1046 ◽  
Author(s):  
Peng R. Chen ◽  
Sepideh Amin-Hanjani ◽  
Felipe C. Albuquerque ◽  
Cameron McDougall ◽  
Joseph M. Zabramski ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Artery Aneurysm ◽  
Complete Recovery ◽  
Treatment Method ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Surgical Patients ◽  
Oculomotor Nerve Palsy ◽  
Endovascular Coiling ◽  
Posterior Communicating Artery Aneurysm

Abstract OBJECTIVE: Recovery of posterior communicating artery aneurysm-induced oculomotor nerve palsy (ONP) after aneurysm coiling has been reported. However, the coil mass may compromise recovery of the nerve. Therefore, we compared the outcome of coiling and clipping for this indication. METHODS: We retrospectively compared the outcomes of ONP in 13 patients, six of whom underwent endovascular coiling and seven of whom underwent surgical clipping. RESULTS: Six of the seven surgical patients with ONP recovered completely, compared with two of the six patients in the endovascular group. Of the patients with more than 1 year of follow-up, all six surgical patients recovered completely, compared with two of four endovascular patients (P = 0.05). In addition, preoperative complete or partial ONP also was associated with degree of resolution by survival analysis (P = 0.03). All patients with partial ONP in the surgical group and two of three patients in the endovascular group recovered without residual deficits, whereas three of the four patients with complete ONP in the clipping group and none in the coiling group recovered completely. Regardless of the treatment method, time to complete resolution of ONP was 6 months in both groups. CONCLUSION: Clipping posterior communicating artery aneurysms was associated with a higher probability of complete recovery from ONP than coiling. Degree of preoperative ONP also affected recovery. If patients can tolerate surgery, it should be considered the treatment of choice.

Republished: Simultaneous stent expansion/balloon deflation technique to salvage failed balloon remodeling

2015 ◽  
Vol 8 (4) ◽  
pp. e15-e15 ◽  
Author(s):  
Travis R Ladner ◽  
Lucy He ◽  
Brandon J Davis ◽  
Michael T Froehler ◽  
J Mocco
Keyword(s):  
Artery Aneurysm ◽  
Left Internal Carotid Artery ◽  
Parent Vessel ◽  
Stent Deployment ◽  
Stent Expansion ◽  
Bifurcation Aneurysm ◽  
Closed Cell ◽  
Procedural Complications ◽  
Posterior Communicating Artery Aneurysm ◽  
Wide Neck

Herniation, with possible embolization, of coils into the parent vessel following aneurysm coiling remains a frequent challenge. For this reason, balloon or stent assisted embolization remains an important technique. Despite the use of balloon remodeling, there are occasions where, on deflation of the balloon, some coils, or even the entire coil mass, may migrate. We report the successful use of a simultaneous adjacent stent deployment bailout technique in order to salvage coil prolapse during balloon remodeling in three patients. Case No 1 was a wide neck left internal carotid artery bifurcation aneurysm, measuring 9 mm×7.9 mm×6 mm with a 5 mm neck. Case No 2 was a complex left superior hypophyseal artery aneurysm, measuring 5.3 mm×4 mm×5 mm with a 2.9 mm neck. Case No 3 was a ruptured right posterior communicating artery aneurysm, measuring 4 mm×4 mm×4.5 mm with a 4 mm neck. This technique successfully returned the prolapsed coil mass into the aneurysm sac in all cases without procedural complications. The closed cell design of the Enterprise VRD (Codman and Shurtleff Inc, Raynham, Massachusetts, USA) makes it ideal for this bailout technique, by allowing the use of an 0.021 inch delivery catheter (necessary for simultaneous access) and by avoiding the possibility of an open cell strut getting caught on the deflated balloon. We hope this technique will prove useful to readers who may find themselves in a similar predicament.

scholarly journals Horizontal Stenting via Retrograde Route for Recurrent Ruptured Posterior Communicating Artery Aneurysm after Clipping: A Case Report and Literature Review

2021 ◽  
Author(s):  
Michiyasu Fuga ◽  
Toshihide Tanaka ◽  
Rintaro Tachi ◽  
Ryo Nogami ◽  
Akihiko Teshigawara ◽  
...  
Keyword(s):  
Case Report ◽  
Internal Carotid ◽  
Posterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Posterior Communicating Artery ◽  
Coil Embolisation ◽  
Ruptured Aneurysms ◽  
Branch Vessel ◽  
Posterior Communicating Artery Aneurysm ◽  
Contralateral Internal Carotid Artery

Treatment of recurrent ruptured aneurysms incorporating a branch vessel arising from the dome is challenging. Here, we attempted horizontal stent-assisted coil embolisation via a retrograde route from the contralateral internal carotid artery to treat a small ruptured posterior communicating artery aneurysm incorporating a foetal variant posterior cerebral artery after clipping.

Oculomotor Nerve Palsy Due To Posterior Communicating Artery Aneurysm: Clipping vs Coiling

2021 ◽  
Author(s):  
Alexandrina S. Nikova ◽  
Georgios S Sioutas ◽  
Katerina Sfyrlida ◽  
Grigorios Tripsianis ◽  
Michael Karanikas ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Artery Aneurysm ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Oculomotor Nerve Palsy ◽  
Aneurysm Clipping ◽  
Posterior Communicating Artery Aneurysm
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