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Microguidewire protection of wide-necked aneurysms incorporating orifices of tortuous acute-angled vessels: a novel approach.
MedLine Citation:
PMID:  24756166     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
INTRODUCTION: Protective/remodeling techniques for treating wide-necked intracranial aneurysms are constantly sought. However, their utility may be limited in lesions that incorporate the orifice of acute-angled efferent branch vessels. Furthermore, passage of a protective microcatheter may be challenging if a small branch is extremely tortuous. This study was conducted to explore a novel method of treating wide-necked aneurysms, utilizing microguidewire protection.
METHODS: A microcatheter is first passed into parent artery (proximal to aneurysm) to position a microguidewire proximally in the involved branch. A second microcatheter is then inserted into aneurysmal sac. Advancement of the first microcatheter forces the microguidewire to shift, thus covering aneurysmal neck. A framing coil may then be placed within aneurysmal sac, under microguidewire protection. After completing initial coil insertion, easing of tension on the microcatheter allows separation of protective microguidewire and frame coil, confirming stability of the initial coil.
RESULTS: This technique was applied to 11 intracranial saccular aneurysms of M1 segment (n = 6), middle cerebral artery bifurcation (n = 4), and anterior communicating artery (n = 1) with success, combining stent protection in two patients. Coil embolization was thus facilitated, resulting in excellent outcomes for all patients. No morbidity or mortality was directly related to microguidewire protection.
CONCLUSION: Our small study suggests that microguidewire protection may be a safe alternative, if traditional remodeling or protective options are infeasible due to intrinsic vascular properties. This technique is particularly suited for treatment of wide-necked aneurysms where passage of protective microcatheters into involved branches is not achievable.
Authors:
Young Dae Cho; Hyun-Seung Kang; Jeong Eun Kim; Jun Hyong Ahn; Seung Chai Jung; Chang Hun Kim; Moon Hee Han
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-4-23
Journal Detail:
Title:  Neuroradiology     Volume:  -     ISSN:  1432-1920     ISO Abbreviation:  Neuroradiology     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-4-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1302751     Medline TA:  Neuroradiology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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