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Embolisation of internal carotid artery aneurysm using the double microcatheter technique - a case report.

Juszkat R, Stanisławska K, Kopińska K, Liebert W, Moskal J - Pol J Radiol (2015)

Bottom Line: To overcome possible complications of endovascular treatment of this type of aneurysms, methods like intracranial stents, balloon remodelling, the double microcatheter and the microcatheter protective technique have been developed.Introduction of the second microcatheter into the aneurysm allowed for crossing two coils and prevented protrusion into the parent vessel, which resulted in successful treatment without postprocedural complications.This technique is easy to perform for an experienced neuroradiologist.

View Article: PubMed Central - PubMed

Affiliation: Department of General and Interventional Radiology, Poznań University of Medical Sciences, Poznań, Poland.

ABSTRACT

Background: A wide-necked aneurysm is defined as the one with a neck greater than 4 mm in diameter. Embolisation of wide-necked aneurysms is a great challenge for neuroradiologists. To overcome possible complications of endovascular treatment of this type of aneurysms, methods like intracranial stents, balloon remodelling, the double microcatheter and the microcatheter protective technique have been developed.

Case report: We report a case of embolisation of a 63-year-old woman with a wide-necked aneurysm using the double microcatheter technique. Introduction of the second microcatheter into the aneurysm allowed for crossing two coils and prevented protrusion into the parent vessel, which resulted in successful treatment without postprocedural complications. Both postembolic and follow-up angiography showed complete exclusion of the aneurysm.

Conclusions: The double microcatheter technique, owing to creation of a stable coil frame across the neck of the aneurysm, is suitable for treatment of aneurysms with an adverse dome-to-neck ratio. This technique is easy to perform for an experienced neuroradiologist.

No MeSH data available.


Related in: MedlinePlus

Postembolic angiogram showing complete aneurysmal occlusion.
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f3-poljradiol-80-191: Postembolic angiogram showing complete aneurysmal occlusion.

Mentions: A 63-year-old woman experiencing recurrent headaches without focal neurological deficits was directed to computer tomography (CT) examination which revealed an unruptured aneurysm in the right internal carotid artery. She was admitted to the Department of Neurosurgery and Neurotraumatology, in Poznań, with the aim of undergoing endovascular treatment. Digital subtraction angiography in access via the right femoral artery showed an aneurysm in the right internal carotid artery, in the ophthalmic segment, measuring 7.4×4.2 mm, with an unfavourable configuration (the neck measured 3.4 mm) (Figure 1). The decision of ad hoc embolisation was made. The procedure was carried out under general anaesthesia. The patient received 5000 IU of heparin intravenously (i.v.). What is important, the aneurysm configuration was not an a priori indication for stent-assisted embolisation. Firstly, standard embolisation with one microcatheter was performed (Vasco 10, Balt, Montmorency, France), but protrusion of the loop of the coil into the parent vessel was noticed (Figure 2A). After several attempts, it was decided to treat the patient using the double microcatheter technique. In case of unsuccessful treatment with the double microcatheter technique, the use of balloon remodelling technique would be considered. Two microcatheters (both Vasco 10, Balt) were introduced one by one, through the same guiding catheter, and positioned within the aneurysm. Afterwards, two coils (Target 360 Standard Coils 5×15 Stryker Cork, Ireland) were implanted simultaneously as an initial stable basket-frame for the next coils (Figure 2B). Together, four coils were implanted. Postembolic angiography showed complete exclusion of the aneurysm (Figure 3). After the procedure, the patient did not present any neurological deficits and the general clinical status was good. Angiographic follow-up was performed after 6 months and revealed no interval change (Figure 4).


Embolisation of internal carotid artery aneurysm using the double microcatheter technique - a case report.

Juszkat R, Stanisławska K, Kopińska K, Liebert W, Moskal J - Pol J Radiol (2015)

Postembolic angiogram showing complete aneurysmal occlusion.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4400969&req=5

f3-poljradiol-80-191: Postembolic angiogram showing complete aneurysmal occlusion.
Mentions: A 63-year-old woman experiencing recurrent headaches without focal neurological deficits was directed to computer tomography (CT) examination which revealed an unruptured aneurysm in the right internal carotid artery. She was admitted to the Department of Neurosurgery and Neurotraumatology, in Poznań, with the aim of undergoing endovascular treatment. Digital subtraction angiography in access via the right femoral artery showed an aneurysm in the right internal carotid artery, in the ophthalmic segment, measuring 7.4×4.2 mm, with an unfavourable configuration (the neck measured 3.4 mm) (Figure 1). The decision of ad hoc embolisation was made. The procedure was carried out under general anaesthesia. The patient received 5000 IU of heparin intravenously (i.v.). What is important, the aneurysm configuration was not an a priori indication for stent-assisted embolisation. Firstly, standard embolisation with one microcatheter was performed (Vasco 10, Balt, Montmorency, France), but protrusion of the loop of the coil into the parent vessel was noticed (Figure 2A). After several attempts, it was decided to treat the patient using the double microcatheter technique. In case of unsuccessful treatment with the double microcatheter technique, the use of balloon remodelling technique would be considered. Two microcatheters (both Vasco 10, Balt) were introduced one by one, through the same guiding catheter, and positioned within the aneurysm. Afterwards, two coils (Target 360 Standard Coils 5×15 Stryker Cork, Ireland) were implanted simultaneously as an initial stable basket-frame for the next coils (Figure 2B). Together, four coils were implanted. Postembolic angiography showed complete exclusion of the aneurysm (Figure 3). After the procedure, the patient did not present any neurological deficits and the general clinical status was good. Angiographic follow-up was performed after 6 months and revealed no interval change (Figure 4).

Bottom Line: To overcome possible complications of endovascular treatment of this type of aneurysms, methods like intracranial stents, balloon remodelling, the double microcatheter and the microcatheter protective technique have been developed.Introduction of the second microcatheter into the aneurysm allowed for crossing two coils and prevented protrusion into the parent vessel, which resulted in successful treatment without postprocedural complications.This technique is easy to perform for an experienced neuroradiologist.

View Article: PubMed Central - PubMed

Affiliation: Department of General and Interventional Radiology, Poznań University of Medical Sciences, Poznań, Poland.

ABSTRACT

Background: A wide-necked aneurysm is defined as the one with a neck greater than 4 mm in diameter. Embolisation of wide-necked aneurysms is a great challenge for neuroradiologists. To overcome possible complications of endovascular treatment of this type of aneurysms, methods like intracranial stents, balloon remodelling, the double microcatheter and the microcatheter protective technique have been developed.

Case report: We report a case of embolisation of a 63-year-old woman with a wide-necked aneurysm using the double microcatheter technique. Introduction of the second microcatheter into the aneurysm allowed for crossing two coils and prevented protrusion into the parent vessel, which resulted in successful treatment without postprocedural complications. Both postembolic and follow-up angiography showed complete exclusion of the aneurysm.

Conclusions: The double microcatheter technique, owing to creation of a stable coil frame across the neck of the aneurysm, is suitable for treatment of aneurysms with an adverse dome-to-neck ratio. This technique is easy to perform for an experienced neuroradiologist.

No MeSH data available.


Related in: MedlinePlus