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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

Illustrative case.A. Paraclinoid aneurysm with superior direction on left internal carotid artery (ICA) angiography. B. After microcatheter was shaped to "S" using steam, looping of microcatheter tip was achieved using microguidewire loop. Looped microcatheter was advanced into distal ICA over aneurysm. C. Microcatheter tip was directed differently from aneurysm direction. D. Inferiorly directed microcatheter was steered superiorly to align with dome of aneurysm. E. Tension of microcatheter was released to select aneurysm, and then microcatheter tip was inserted into aneurysm sac, untying loop. F. Coil embolization was performed using balloon protection. G. Aneurysm was completely occluded. H. Six-month follow-up MR angiography showed that aneurysm was stably occluded.
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Figure 3: Illustrative case.A. Paraclinoid aneurysm with superior direction on left internal carotid artery (ICA) angiography. B. After microcatheter was shaped to "S" using steam, looping of microcatheter tip was achieved using microguidewire loop. Looped microcatheter was advanced into distal ICA over aneurysm. C. Microcatheter tip was directed differently from aneurysm direction. D. Inferiorly directed microcatheter was steered superiorly to align with dome of aneurysm. E. Tension of microcatheter was released to select aneurysm, and then microcatheter tip was inserted into aneurysm sac, untying loop. F. Coil embolization was performed using balloon protection. G. Aneurysm was completely occluded. H. Six-month follow-up MR angiography showed that aneurysm was stably occluded.

Mentions: A 32-year-old woman was admitted for endovascular treatment of an unruptured paraclinoid aneurysm (maximum diameter, 3.3 mm; dome-to-neck ratio, 1.1) with small bleb. She was seeking treatment because of her young age and a family history of subarachnoid hemorrhage. A 6-Fr guiding catheter was advanced into cervical ICA. Because the aneurysm was superiorly directed (relative to carotid siphon), an S-shaped microcatheter (Excelsior SL-10, Stryker, Fremont, CA, USA) was configured by steaming. Traditional maneuvers, including forward or backward movement and inner microguidewire steering, failed to select the aneurysm. After looping of the microcatheter (via microguidewire loop) in cavernous ICA, it was advanced to distal ICA, overlying the aneurysm. The inferiorly directed microcatheter was steered superiorly to align with the dome of aneurysm. Slow release of tension on the microcatheter subsequently allowed its tip to enter aneurysmal sac. Thereafter, coil insertion was performed under the balloon protection. Post-embolization angiography showed successful occlusion of the aneurysm sac, and the patient was discharged the following day, free of complications. At a 6-month follow-up visit, magnetic resonance angiography confirmed stable occlusion of aneurysm (Fig. 3).


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)

Illustrative case.A. Paraclinoid aneurysm with superior direction on left internal carotid artery (ICA) angiography. B. After microcatheter was shaped to "S" using steam, looping of microcatheter tip was achieved using microguidewire loop. Looped microcatheter was advanced into distal ICA over aneurysm. C. Microcatheter tip was directed differently from aneurysm direction. D. Inferiorly directed microcatheter was steered superiorly to align with dome of aneurysm. E. Tension of microcatheter was released to select aneurysm, and then microcatheter tip was inserted into aneurysm sac, untying loop. F. Coil embolization was performed using balloon protection. G. Aneurysm was completely occluded. H. Six-month follow-up MR angiography showed that aneurysm was stably occluded.
© Copyright Policy - open-access
Related In: Results  -  Collection

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Figure 3: Illustrative case.A. Paraclinoid aneurysm with superior direction on left internal carotid artery (ICA) angiography. B. After microcatheter was shaped to "S" using steam, looping of microcatheter tip was achieved using microguidewire loop. Looped microcatheter was advanced into distal ICA over aneurysm. C. Microcatheter tip was directed differently from aneurysm direction. D. Inferiorly directed microcatheter was steered superiorly to align with dome of aneurysm. E. Tension of microcatheter was released to select aneurysm, and then microcatheter tip was inserted into aneurysm sac, untying loop. F. Coil embolization was performed using balloon protection. G. Aneurysm was completely occluded. H. Six-month follow-up MR angiography showed that aneurysm was stably occluded.
Mentions: A 32-year-old woman was admitted for endovascular treatment of an unruptured paraclinoid aneurysm (maximum diameter, 3.3 mm; dome-to-neck ratio, 1.1) with small bleb. She was seeking treatment because of her young age and a family history of subarachnoid hemorrhage. A 6-Fr guiding catheter was advanced into cervical ICA. Because the aneurysm was superiorly directed (relative to carotid siphon), an S-shaped microcatheter (Excelsior SL-10, Stryker, Fremont, CA, USA) was configured by steaming. Traditional maneuvers, including forward or backward movement and inner microguidewire steering, failed to select the aneurysm. After looping of the microcatheter (via microguidewire loop) in cavernous ICA, it was advanced to distal ICA, overlying the aneurysm. The inferiorly directed microcatheter was steered superiorly to align with the dome of aneurysm. Slow release of tension on the microcatheter subsequently allowed its tip to enter aneurysmal sac. Thereafter, coil insertion was performed under the balloon protection. Post-embolization angiography showed successful occlusion of the aneurysm sac, and the patient was discharged the following day, free of complications. At a 6-month follow-up visit, magnetic resonance angiography confirmed stable occlusion of aneurysm (Fig. 3).

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