Document Detail

Microcatheter neck bridging and incorporated branch vessel protection for coil embolization of a wide-neck ruptured aneurysm: technical case report.
MedLine Citation:
PMID:  21206323     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND IMPORTANCE: A novel technique in which microcatheter neck bridging of a ruptured wide-neck posterior communicating artery aneurysm was performed by intra-aneurysmal catheter navigation into a fetal configuration posterior cerebral artery (PCA) branch vessel arising from the sac.
CLINICAL PRESENTATION: An 88-year-old woman with a Hunt and Hess grade 1 and Fisher grade 4 subarachnoid hemorrhage was identified as having a wide-neck posterior communicating artery aneurysm and an isolated fetal configuration PCA with origins from the aneurysm sac. Delivery of a bare platinum Guglielmi detachable coil within the aneurysm lumen resulted in persistent coil prolapse into the parent vessel with occlusion of the incorporated vital PCA origin. A microcatheter was then navigated through the aneurysm lumen and into the fetal configuration PCA. This was retained within the PCA with resultant aneurysm neck narrowing and branch vessel protection. A second microcatheter was placed in the aneurysm lumen for coil delivery. Complete aneurysm occlusion with patency of the PCA without coil loop prolapse into the parent vessel was achieved.
CONCLUSION: The presence of normal branch vessels arising from the dome is a limitation for endovascular techniques. To the best of our knowledge, no prior description of a dual-microcatheter technique with selective catheter placement within an important intra-aneurysmal branch vessel has been published. The vital branch vessel was protected and the wide-neck aneurysm completely occluded. Novel placement of microcatheters further expands the range of complex configuration aneurysms amenable to endovascular coiling.
Ajeet Gordhan
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Publication Detail:
Type:  Case Reports; Journal Article; Technical Report    
Journal Detail:
Title:  Neurosurgery     Volume:  68     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-04-11     Completed Date:  2011-06-21     Revised Date:  2011-08-25    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  40-3; discussion 43-4     Citation Subset:  IM    
St. Joseph Medical Center, Department of Neurointerventional Radiology, Bloomington, Illinois 61701, USA.
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MeSH Terms
Aged, 80 and over
Aneurysm, Ruptured / complications,  surgery*
Angiography, Digital Subtraction / methods
Embolization, Therapeutic / instrumentation*,  methods*
Endovascular Procedures / methods
Intracranial Aneurysm / complications,  surgery*

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