Document Detail


Stent remodeling technique for coiling of ruptured wide-neck cerebral aneurysms: case report.
MedLine Citation:
PMID:  19834390     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To describe a novel stent remodeling technique for the coiling of ruptured wide-neck cerebral aneurysms. CLINICAL PRESENTATION: A 46-year-old man presented with acute subarachnoid hemorrhage (Hunt and Hess grade IV), intracerebral hemorrhage, and hydrocephalus. Cerebral angiography revealed a wide-neck small anterior communicating artery aneurysm. Conventional coiling was not successful because of coil instability and compromise of the dominant anterior cerebral artery. TECHNIQUE: A 6-French shuttle sheath (Cook Medical, Indianapolis, IN) was advanced from a right femoral approach into the right common carotid artery. To protect the parent vessel during coiling without compromising blood flow, a Prowler Select Plus catheter (Cordis Corporation, Bridgewater, NJ) was navigated across the aneurysm neck. Subsequently, an Enterprise stent (22-mm length; Cordis Corporation) was partially deployed across the aneurysm's wide neck. It was very important to watch the distal markers of the stent and lock the stent delivery wire to the Prowler Select Plus with a hemostatic valve once the stent was halfway deployed. This maneuver was essential to prevent further deployment of the stent. The SL-10 microcatheter and Synchro 14 wire (Boston Scientific, Natick, MA) were carefully navigated to the aneurysm passing through the partially deployed stent. Coils were then delivered to the aneurysm using the stent as a scaffold. After coiling, the SL-10 microcatheter was removed and the stent was recaptured into the Prowler Select Plus catheter. During the recapture, there was initial resistance. This was easily overcome after deploying the stent a little more before resheathing. During the procedure, the patient received 2000 U of heparin after the first coil was detached in the aneurysm. CONCLUSION: The stent remodeling technique is a novel endovascular technique that can be used to treat ruptured wide-neck aneurysms and maintain patency of parent vessels, avoiding the use of antiplatelet therapy in acute subarachnoid hemorrhage.
Authors:
Demetrius K Lopes; Kalani Wells
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  65     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-16     Completed Date:  2009-12-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E1007-8; discussion E1008     Citation Subset:  IM    
Affiliation:
Cerebrovascular Program, Rush University, Chicago Institute of Neurosurgery and Neuroresearch, Chicago, Illinois, USA. brainaneurysm@mac.com
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MeSH Terms
Descriptor/Qualifier:
Aneurysm, Ruptured / complications,  surgery*
Embolization, Therapeutic / instrumentation*,  methods*
Humans
Intracranial Aneurysm / complications,  surgery*
Male
Middle Aged
Neurosurgical Procedures / instrumentation,  methods
Stents
Subarachnoid Hemorrhage / etiology,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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