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Alpha horizontal stent delivery for coil embolization of a broad-necked large basilar apex aneurysm: a case report.

Ohshima T, Nagakura M, Nishizawa T, Kato K - Nagoya J Med Sci (2015)

Bottom Line: Due to difficulty accessing the right posterior cerebral artery (PCA), we abandoned the Y-stent technique.The procedure outcome was excellent without any complications.Alpha horizontal stent delivery via an antegrade approach for coil embolization of broad-necked large BA apex aneurysms may provide an effective therapeutic alternative, if other techniques are not feasible.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.

ABSTRACT
Here we describe a novel technique for single stent horizontal reconstruction and coil embolization for a broad-necked large basilar artery (BA) apex aneurysm. A previously healthy 77-year-old woman presented with a broad-necked large BA apex aneurysm. Due to difficulty accessing the right posterior cerebral artery (PCA), we abandoned the Y-stent technique. Instead, we decided to navigate the stent through the BA to the left PCA making a loop of the stent delivery catheter inside the aneurysm in an "alpha" fashion. The procedure outcome was excellent without any complications. Alpha horizontal stent delivery via an antegrade approach for coil embolization of broad-necked large BA apex aneurysms may provide an effective therapeutic alternative, if other techniques are not feasible.

No MeSH data available.


Related in: MedlinePlus

Final post-procedure image showing successfully re-established arterial flow.
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fig5: Final post-procedure image showing successfully re-established arterial flow.

Mentions: The patient was prescribed 75 mg of clopidogrel and 100 mg of aspirin per day, 10 days prior to the intervention. The procedure was performed on a biplane flat-panel angiographic unit (GE Healthcare; Milwaukee, WI, USA) under general anesthesia with systemic heparinization (activated clotting time >250 s). A 4-French short sheath was inserted into the right brachial artery and an 80-cm 4-French guiding catheter was advanced into the right vertebral artery. An SL-10 (Boston Scientific; Natick, MA, USA), configured into a C shape with steam, was navigated into the aneurysm for coil delivery, while a 5-French guiding sheath (Destination; Terumo, Tokyo, Japan) was inserted into the right femoral artery and advanced up to the left vertebral artery as a second guide. A 120-cm 4-French catheter (Fubuki; Asahi Intecc, Nagoya, Japan) and a Prowler Select Plus (Cordis; Miami Lakes, FL, USA) were inserted into the 5-French guiding sheath by means of the coaxial system. The 4-French Fubuki catheter was carefully placed into the body of the BA apex aneurysm. Subsequently, a 0.014 microguidewire (CHIKAI; Asahi Intecc, Nagoya, Japan) was then carefully advanced forward along the inner wall of the aneurysm until it made a loop inside the aneurysm to reach the left P1 segment. A microcatheter (Prowler Select Plus) was then advanced over the wire and placed distal to the left P1 (Figure 2 and 3). The intra-aneurysmal 4-French catheter played an important role as a stabilizer preventing the "alpha" looped microcatheter from flattening. A 4.5 mm × 22 mm Cordis Enterprise™ vascular reconstruction device (VRD) was delivered into the "alpha" fashioned microcatheter in a horizontal configuration across the base of the broad-necked BA apex aneurysm from the left P1. After insertion of a framing coil (Complex18 9 × 23; Terumo) for anchoring via the right brachial route, the stent was carefully deployed. Successful placement of the stent across the wide aneurysmal neck was confirmed by angiography (Figure 4). Subsequent coil embolization ensued to completion with a total of 30 coils (HydroFrame, HydroSoft; Terumo). There was no evidence of coil protrusion in any of the parent arteries, the BA or bilateral P1. A final angiogram revealed 90% body-filling (Figure 5). The patient demonstrated no neurological deficits and was subsequently discharged seven days after the intervention. MRI at her 12-month follow-up revealed no reperfusion and confirmed patency of both P1 vessels (Figure 6).


Alpha horizontal stent delivery for coil embolization of a broad-necked large basilar apex aneurysm: a case report.

Ohshima T, Nagakura M, Nishizawa T, Kato K - Nagoya J Med Sci (2015)

Final post-procedure image showing successfully re-established arterial flow.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664598&req=5

fig5: Final post-procedure image showing successfully re-established arterial flow.
Mentions: The patient was prescribed 75 mg of clopidogrel and 100 mg of aspirin per day, 10 days prior to the intervention. The procedure was performed on a biplane flat-panel angiographic unit (GE Healthcare; Milwaukee, WI, USA) under general anesthesia with systemic heparinization (activated clotting time >250 s). A 4-French short sheath was inserted into the right brachial artery and an 80-cm 4-French guiding catheter was advanced into the right vertebral artery. An SL-10 (Boston Scientific; Natick, MA, USA), configured into a C shape with steam, was navigated into the aneurysm for coil delivery, while a 5-French guiding sheath (Destination; Terumo, Tokyo, Japan) was inserted into the right femoral artery and advanced up to the left vertebral artery as a second guide. A 120-cm 4-French catheter (Fubuki; Asahi Intecc, Nagoya, Japan) and a Prowler Select Plus (Cordis; Miami Lakes, FL, USA) were inserted into the 5-French guiding sheath by means of the coaxial system. The 4-French Fubuki catheter was carefully placed into the body of the BA apex aneurysm. Subsequently, a 0.014 microguidewire (CHIKAI; Asahi Intecc, Nagoya, Japan) was then carefully advanced forward along the inner wall of the aneurysm until it made a loop inside the aneurysm to reach the left P1 segment. A microcatheter (Prowler Select Plus) was then advanced over the wire and placed distal to the left P1 (Figure 2 and 3). The intra-aneurysmal 4-French catheter played an important role as a stabilizer preventing the "alpha" looped microcatheter from flattening. A 4.5 mm × 22 mm Cordis Enterprise™ vascular reconstruction device (VRD) was delivered into the "alpha" fashioned microcatheter in a horizontal configuration across the base of the broad-necked BA apex aneurysm from the left P1. After insertion of a framing coil (Complex18 9 × 23; Terumo) for anchoring via the right brachial route, the stent was carefully deployed. Successful placement of the stent across the wide aneurysmal neck was confirmed by angiography (Figure 4). Subsequent coil embolization ensued to completion with a total of 30 coils (HydroFrame, HydroSoft; Terumo). There was no evidence of coil protrusion in any of the parent arteries, the BA or bilateral P1. A final angiogram revealed 90% body-filling (Figure 5). The patient demonstrated no neurological deficits and was subsequently discharged seven days after the intervention. MRI at her 12-month follow-up revealed no reperfusion and confirmed patency of both P1 vessels (Figure 6).

Bottom Line: Due to difficulty accessing the right posterior cerebral artery (PCA), we abandoned the Y-stent technique.The procedure outcome was excellent without any complications.Alpha horizontal stent delivery via an antegrade approach for coil embolization of broad-necked large BA apex aneurysms may provide an effective therapeutic alternative, if other techniques are not feasible.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.

ABSTRACT
Here we describe a novel technique for single stent horizontal reconstruction and coil embolization for a broad-necked large basilar artery (BA) apex aneurysm. A previously healthy 77-year-old woman presented with a broad-necked large BA apex aneurysm. Due to difficulty accessing the right posterior cerebral artery (PCA), we abandoned the Y-stent technique. Instead, we decided to navigate the stent through the BA to the left PCA making a loop of the stent delivery catheter inside the aneurysm in an "alpha" fashion. The procedure outcome was excellent without any complications. Alpha horizontal stent delivery via an antegrade approach for coil embolization of broad-necked large BA apex aneurysms may provide an effective therapeutic alternative, if other techniques are not feasible.

No MeSH data available.


Related in: MedlinePlus