Intra aneurysmal double microcatheter technique for complex aneurysm

BackgroundFlow diversion (FD) is a common treatment modality for complex intracranial aneurysms. A major concern regarding the use of FD is thromboembolic events (TEE). There is debate surrounding the optimal antiplatelet regimen to prevent TEE. We aim to evaluate the safety and efficacy of ticagrelor as a single antiplatelet therapy (SAPT) for the prevention of TEE following FD for complex aneurysm treatment.MethodsA retrospective review of a prospectively maintained neuroendovascular database at three endovascular centers was performed. Patients were included if they had an intracranial aneurysm that was treated with FD between January 2018 and September 2019 and were treated with ticagrelor as SAPT. Primary outcomes included early (within 72 hours post-procedure) and late (within 6 months) ischemic events.ResultsA total of 24 patients (mean age 47.7 years) with 36 aneurysms were eligible for analysis, including 15 (62.5%) females. 14 (58.3%) patients presented with subarachnoid hemorrhage. 35 aneurysms arose from the anterior circulation and 1 from the posterior circulation. 23 aneurysms had a saccular morphology, whereas 7 were fusiform and 6 were blister. For the treatment of all 36 aneurysms, 30 procedures were performed with 32 FD devices. Procedural in-stent thrombosis occurred in 2 cases and was treated with intra-arterial tirofiban without complications. Aneurysm re-bleeding was reported in 1 (4.2%) patient. There were no reported early or late TEE. Three patients discontinued ticagrelor due to systemic side effects.ConclusionTicagrelor is a safe and effective SAPT for the prevention of TEE after FD. Large multicenter prospective studies are warranted to validate our findings.

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Quantifying asymmetry of anterior cerebral arteries as a predictor of anterior communicating artery complex aneurysm

BMJ Surgery, Interventions, & Health Technologies ◽

10.1136/bmjsit-2020-000059 ◽

2020 ◽

Vol 2 (1) ◽

pp. e000059

Author(s):

Arjun Burlakoti ◽

Jaliya Kumaratilake ◽

David J Taylor ◽

Maciej Henneberg

Keyword(s):

Significant Contribution ◽

Anterior Cerebral Artery ◽

Cerebral Arteries ◽

South Australia ◽

General Information ◽

Anterior Communicating Artery ◽

Cross Sectional ◽

Complex Aneurysm ◽

Measured Position ◽

Cerebral Computed Tomography

ObjectivesThe aim of this study was to establish an anatomical index for early prediction of the risk of development of aneurysms in anterior communicating arterial complex (AcomAC). The asymmetric diameter of one anterior cerebral artery (ACA) to other could alter haemodynamics and may contribute to formation of aneurysms in AcomAC and be a reliable predictor of the risk of development of aneurysms.Design and settingThis is a retrospective, observational and quantitative study, which used cerebral computed tomography angiography (CCTA) scans in South Australia.ParticipantsCCTA scans of 166 adult patients of both sexes were studied.Main outcome measuresThe internal diameters of the proximal segments of ACAs (A1s) were measured. Position and presence or absence of aneurysms in AcomAC were determined. The ratio of A1 diameters was taken as a measure of A1 asymmetry.ResultsThe ratio of diameters of A1s correlated with the occurrence of AcomAC aneurysms. The risk of development of aneurysms in AcomAC was much greater (80%, OR=47.3) when one A1 segment’s radius was at least 50% larger (ie, 2.25 times cross-sectional area) than the other.ConclusionThe general information on asymmetric A1 has been published previously. The present findings have significant contribution since the A1s asymmetry ratios have been categorised in ascending order and matched with the presence of AcomAC aneurysms. The asymmetry ratio of the A1 is a good predictor for the development of AcomAC aneurysms. Reconstruction of the asymmetric A1 could be done if the technology gets advanced.

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Applications of the Columbus steerable guidewire

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-018120 ◽

2021 ◽

pp. neurintsurg-2021-018120

Author(s):

Alexander von Hessling ◽

Tomás Reyes del Castillo ◽

Lutz Lehmann ◽

Justus Erasmus Roos ◽

Grzegorz Karwacki

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Curvature Radius ◽

Content Type ◽

Complex Aneurysm ◽

Media Player ◽

First Case ◽

Great Support ◽

Basilar Tip Aneurysm ◽

Video Player

The Columbus steerable guidewire (Rapid Medical, Israel) is a 0.014 inch guidewire with a remotely controlled deflectable tip intended for neuronavigational purposes. 1 The tip can be shaped by pulling or pushing the handle. Pulling the handle decreases the radius (from 4 mm to 2 mm) and curves the tip, while pushing the handle increases the curvature radius and straightens the tip until it bends in the opposite direction. The amount of deflection is at the discretion of the operator. Video 1 The response of the Columbus guidewire to rotational movements is inferior to that of standard wires, and the tip is very soft and malleable but brings great support when bent. We present two cases where the Columbus guidewire was used. In the first case, the Columbus enabled us to probe a posterior cerebral artery arising from a giant basilar tip aneurysm without wall contact. In the second case, the Columbus was used as a secondary wire to help cannulate the pericallosal artery in a patient with a recurrent anterior complex aneurysm; this subsequently permitted successful stent-assisted coiling of the aneurysm.Video 1

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