Visualization of Aneurysmal Neck and Dome after Coiling with 3D Multifusion Imaging of Silent MRA and FSE-MR Cisternography

A 56-year-old male was found to have a basilar artery aneurysm by magnetic resonance imaging. Angiography demonstrated a broad neck basilar tip aneurysm. He refused surgical clipping but accepted intravascular embolisation. Introducing catheters were inserted into each of the bilateral vertebral arteries. A microcatheter was introduced into the aneurysm through one of the introducing catheters and a double lumen balloon catheter was introduced into the left posterior cerebral artery (PCA) through the other. The balloon was located from the left PCA to the basilar artery across the aneurysmal neck with the aid of a guidewire passed through the inner lumen of the balloon catheter. The balloon was inflated, and a Guglielmi detachable coil (GDC) was inserted until the platinum part was placed inside the aneurysm. The balloon was deflated to confirm the stability of the GDC, and then the GDC was electrically detached. This procedure was repeated until nine GDCs were successfully inserted. The aneurysm was tightly embolised despite its broad neck. Angiography comfirmed complete neck closure and stable preservation of the basilar artery and bilateral PCAs immediately, 1 week, 3 months, 6 months, and 12 months after embolisation without evidence of thrombo-embolic complications. Neck plastic intra-aneurysmal GDC embolisation using a protective balloon can be used to treat broad-neck aneurysms.

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MR cisternography after intrathecal Gd-DTPA application

European Radiology ◽

10.1007/s00330-002-1606-9 ◽

2002 ◽

Vol 12 (12) ◽

pp. 2943-2949 ◽

Cited By ~ 24

Author(s):

Werner Reiche ◽

Yvonne Komenda ◽

Bernhard Schick ◽

Iris Grunwald ◽

Wolf-Ingo Steudel ◽

...

Keyword(s):

Mr Cisternography

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A novel approach involving a microcatheter tip during aneurysmal coil embolization: The Γ (gamma) tip method

Interventional Neuroradiology ◽

10.1177/1591019919850849 ◽

2019 ◽

Vol 25 (6) ◽

pp. 681-684 ◽

Cited By ~ 1

Author(s):

Tomotaka Ohshima ◽

Shigeru Miyachi ◽

Naoki Matsuo ◽

Reo Kawaguchi ◽

Ryuya Maejima ◽

...

Keyword(s):

Coil Embolization ◽

Parent Artery ◽

Hot Air ◽

Dynamic Movement ◽

Air Gun ◽

Novel Approach ◽

Endovascular Coil Embolization ◽

Aneurysmal Neck ◽

Novel Strategy

Complete and secure occlusion of the entire aneurysmal neck remains a problem despite major advances in the treatment of intracranial aneurysms using endovascular coil embolization. Here, we present our initial clinical experience using a novel strategy for endovascular coil embolization involving a microcatheter tip, known as the “Γ (gamma) tip method,” and compare the in vitro results of this technique with those of conventional straight microcatheters. The microcatheters were bent at a right angle starting 1–2 mm from the length of the tip using a catheter-shaping mandrel and a hot air gun. The tiny right-angled tip is the “Γ tip.” In aneurysm models, we assessed the efficacy of shaping during coil deployment. The Γ-tipped microcatheters demonstrated better movement and oscillation during insertion of the coil into the aneurysm compared with the straight-tipped catheters. Moreover, the Γ-tipped microcatheter provided less coil protrusion into the parent artery and less microcatheter kickback compared with the straight tip. With the Γ-tipped microcatheter, even if the first coil loop migrated into the parent artery, its subsequent dynamic movement routed it back into the aneurysm. The Γ tip method enabled smooth movement of the microcatheter into the aneurysm, demonstrating the safety and security of coil insertion using the Γ tip compared with the conventional straight tip.

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An Operative Complication in a Patient with a True Posterior Communicating Artery Aneurysm: Case report and Review of the Literature

Neurosurgery ◽

10.1227/00006123-199010000-00028 ◽

1990 ◽

Vol 27 (4) ◽

pp. 650-653 ◽

Cited By ~ 14

Author(s):

Tadashi Kudo

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Artery Aneurysm ◽

Oculomotor Nerve ◽

Posterior Communicating Artery ◽

Review Of The Literature ◽

Operative Complications ◽

Posterior Communicating Artery Aneurysm ◽

Aneurysmal Neck

Abstract Intraoperative oculomotor nerve injury in a patient with a true posterior communicating artery aneurysm is reported in detail. A comparison of internal carotid artery aneurysms at the posterior communicating artery junction with true posterior communicating artery aneurysms deserves special attention, because the vascular relationships of the aneurysm are more complex. A clip along the internal carotid artery does not occlude blood flow to the aneurysm, and the aneurysmal neck and the distal posterior communicating artery are closer to the oculomotor nerve. This is the 27th reported case of a true posterior communicating artery aneurysm. The incidence of true posterior communicating artery aneurysms ranges from 0.1 to 2.8% of all aneurysm patients. Such aneurysms constitute 4.6 and 11% of so-called posterior communicating aneurysms in two series. Difficulty associated with a preoperative diagnosis has been documented in at least 4 cases. An awareness of this rare aneurysm is stressed in order to avoid operative complications.

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Endosaccular Flow Disruption: A New Frontier in Endovascular Aneurysm Management

Neurosurgery ◽

10.1093/neuros/nyz017 ◽

2019 ◽

Vol 86 (2) ◽

pp. 170-181 ◽

Cited By ~ 3

Author(s):

Adam A Dmytriw ◽

Mohamed M Salem ◽

Victor X D Yang ◽

Timo Krings ◽

Vitor M Pereira ◽

...

Keyword(s):

Paradigm Shift ◽

Intracranial Aneurysms ◽

Parent Artery ◽

Endovascular Techniques ◽

Flow Modification ◽

Flow Disruption ◽

Fda Approval ◽

New Frontier ◽

Trial Basis ◽

Aneurysmal Neck

Abstract Flow modification has caused a paradigm shift in the management of intracranial aneurysms. Since the FDA approval of the Pipeline Embolization Device (Medtronic, Dublin, Ireland) in 2011, it has grown to become the modality of choice for a range of carefully selected lesions, previously not amenable to conventional endovascular techniques. While the vast majority of flow-diverting stents operate from within the parent artery (ie, endoluminal stents), providing a scaffold for endothelial cells growth at the aneurysmal neck while inducing intra-aneurysmal thrombosis, a smaller subset of endosaccular flow disruptors act from within the lesions themselves. To date, these devices have been used mostly in Europe, while only utilized on a trial basis in North America. To the best of our knowledge, there has been no dedicated review of these devices. We therefore sought to present a comprehensive review of currently available endosaccular flow disruptors along with high-resolution schematics, presented with up-to-date available literature discussing their technical indications, procedural safety, and reported outcomes.

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