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Microcatheter Looping to Facilitate Aneurysm Selection in Coil Embolization of Paraclinoid Aneurysms.

Cho YD, Rhim JK, Park JJ, Jeon JS, Yoo RE, Kang HS, Kim JE, Cho WS, Han MH - Korean J Radiol (2015)

Bottom Line: During follow-up of 53 patients (mean interval, 10.9 ± 5.9 months), only one instance (1.9%) of major recanalization was observed.There were no complications related to microcatheter looping.This microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea.

ABSTRACT

Objective: Described herein is a microcatheter looping technique to facilitate aneurysm selection in paraclinoid aneurysms, which remains to be technically challenging due to the inherent complexity of regional anatomy.

Materials and methods: This retrospective study was approved by our Institutional Review Board, and informed consent was waived. Microcatheter looping method was employed in 59 patients with paraclinoid aneurysms between January 2012 and December 2013. In the described technique, construction of a microcatheter loop, which is steam-shaped or pre-shaped, based on the direction of aneurysms, is mandatory. The looped tip of microcatheter was advanced into distal internal carotid artery and positioned atop the target aneurysm. By steering the loop (via inner microguidewire) into the dome of aneurysm and easing tension on the microcatheter, the aneurysm was selected. Clinical and morphologic outcomes were assessed with emphasis on technical aspects of the treatment.

Results: Through this looping technique, a total of 59 paraclinoid aneurysms were successfully treated. After aneurysm selection as described, single microcatheter technique (n = 25) was most commonly used to facilitate coiling, followed by balloon protection (n = 21), stent protection (n = 7), multiple microcatheters (n = 3), and stent/balloon combination (n = 3). Satisfactory aneurysmal occlusion was achieved through coil embolization in 44 lesions (74.6%). During follow-up of 53 patients (mean interval, 10.9 ± 5.9 months), only one instance (1.9%) of major recanalization was observed. There were no complications related to microcatheter looping.

Conclusion: This microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail.

No MeSH data available.


Related in: MedlinePlus

Schematic illustration (II) of microcatheter looping for aneurysm selection.A. Paraclinoid aneurysm with dome superiorly directed; steam configured S-shaped microcatheter looped in cavernous internal carotid artery (ICA). B. Microcatheter tip directed to dome of aneurysm as looped microcatheter advanced to distal ICA. C. Release of microcatheter tension enables insertion into sac of aneurysm.
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Figure 2: Schematic illustration (II) of microcatheter looping for aneurysm selection.A. Paraclinoid aneurysm with dome superiorly directed; steam configured S-shaped microcatheter looped in cavernous internal carotid artery (ICA). B. Microcatheter tip directed to dome of aneurysm as looped microcatheter advanced to distal ICA. C. Release of microcatheter tension enables insertion into sac of aneurysm.

Mentions: The first step of this technique is identifying proper microcatheter shape, according to type of aneurysm and direction of dome (Table 2). The process of making a loop of a microcatheter tip, as next step, is reported elsewhere (713). The looping generally is achieved without great difficulty under the following conditions: 1) the microcatheter passes through carotid siphon; 2) microcatheter advances under the guidance of looped microguidewire between cervical ICA and cavernous ICA; and 3) guiding catheter moves from distal common carotid artery to proximal ICA (with microcatheter placed in proximal external carotid artery). Once formed, the microcatheter loop is advanced to distal ICA and positioned atop the aneurysm. If microcatheter tip and dome of aneurysm are directed differently, the tip may be steered into the dome, via an inner microguidewire. Subsequently, tension on the microcatheter is slowly eased, allowing the tip to insert into dome and the loop to untie. For this purpose, a short, tight angle of microguidewire tip is preferable to a long, loose angle. Microguidewire steering is unnecessary for a microcatheter tip directed similarly to dome of aneurysm (Fig. 2). In some instances, aneurysm selection was achieved simply by advancing the looped microcatheter (Supplementary Video 1 in the online-only Data Supplement).


Microcatheter Looping to Facilitate Aneurysm Selection in Coil Embolization of Paraclinoid Aneurysms.

Cho YD, Rhim JK, Park JJ, Jeon JS, Yoo RE, Kang HS, Kim JE, Cho WS, Han MH - Korean J Radiol (2015)

Schematic illustration (II) of microcatheter looping for aneurysm selection.A. Paraclinoid aneurysm with dome superiorly directed; steam configured S-shaped microcatheter looped in cavernous internal carotid artery (ICA). B. Microcatheter tip directed to dome of aneurysm as looped microcatheter advanced to distal ICA. C. Release of microcatheter tension enables insertion into sac of aneurysm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499556&req=5

Figure 2: Schematic illustration (II) of microcatheter looping for aneurysm selection.A. Paraclinoid aneurysm with dome superiorly directed; steam configured S-shaped microcatheter looped in cavernous internal carotid artery (ICA). B. Microcatheter tip directed to dome of aneurysm as looped microcatheter advanced to distal ICA. C. Release of microcatheter tension enables insertion into sac of aneurysm.
Mentions: The first step of this technique is identifying proper microcatheter shape, according to type of aneurysm and direction of dome (Table 2). The process of making a loop of a microcatheter tip, as next step, is reported elsewhere (713). The looping generally is achieved without great difficulty under the following conditions: 1) the microcatheter passes through carotid siphon; 2) microcatheter advances under the guidance of looped microguidewire between cervical ICA and cavernous ICA; and 3) guiding catheter moves from distal common carotid artery to proximal ICA (with microcatheter placed in proximal external carotid artery). Once formed, the microcatheter loop is advanced to distal ICA and positioned atop the aneurysm. If microcatheter tip and dome of aneurysm are directed differently, the tip may be steered into the dome, via an inner microguidewire. Subsequently, tension on the microcatheter is slowly eased, allowing the tip to insert into dome and the loop to untie. For this purpose, a short, tight angle of microguidewire tip is preferable to a long, loose angle. Microguidewire steering is unnecessary for a microcatheter tip directed similarly to dome of aneurysm (Fig. 2). In some instances, aneurysm selection was achieved simply by advancing the looped microcatheter (Supplementary Video 1 in the online-only Data Supplement).

Bottom Line: During follow-up of 53 patients (mean interval, 10.9 ± 5.9 months), only one instance (1.9%) of major recanalization was observed.There were no complications related to microcatheter looping.This microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea.

ABSTRACT

Objective: Described herein is a microcatheter looping technique to facilitate aneurysm selection in paraclinoid aneurysms, which remains to be technically challenging due to the inherent complexity of regional anatomy.

Materials and methods: This retrospective study was approved by our Institutional Review Board, and informed consent was waived. Microcatheter looping method was employed in 59 patients with paraclinoid aneurysms between January 2012 and December 2013. In the described technique, construction of a microcatheter loop, which is steam-shaped or pre-shaped, based on the direction of aneurysms, is mandatory. The looped tip of microcatheter was advanced into distal internal carotid artery and positioned atop the target aneurysm. By steering the loop (via inner microguidewire) into the dome of aneurysm and easing tension on the microcatheter, the aneurysm was selected. Clinical and morphologic outcomes were assessed with emphasis on technical aspects of the treatment.

Results: Through this looping technique, a total of 59 paraclinoid aneurysms were successfully treated. After aneurysm selection as described, single microcatheter technique (n = 25) was most commonly used to facilitate coiling, followed by balloon protection (n = 21), stent protection (n = 7), multiple microcatheters (n = 3), and stent/balloon combination (n = 3). Satisfactory aneurysmal occlusion was achieved through coil embolization in 44 lesions (74.6%). During follow-up of 53 patients (mean interval, 10.9 ± 5.9 months), only one instance (1.9%) of major recanalization was observed. There were no complications related to microcatheter looping.

Conclusion: This microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail.

No MeSH data available.


Related in: MedlinePlus