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Gaub M, Pathuri S, Gunaji R, Lafuente M, Birnbaum LA, Al Saiegh F, Mascitelli JR. Combination Treatment of Recurrent Basilar Tip and Anterior Communicating Aneurysms With Transcirculation P1-P1 and Y Stenting Techniques: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00989. [PMID: 38047641 DOI: 10.1227/ons.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
- Michael Gaub
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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2
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Shibuya K, Hasegawa H, Suzuki T, Fujiwara H, Shibuma S, Shida K, Oishi M. Usefulness of Y-shaped PulseRider-assisted coil embolization for basilar artery tip aneurysm with a misaligned axis: A case report. Surg Neurol Int 2023; 14:300. [PMID: 37680930 PMCID: PMC10481857 DOI: 10.25259/sni_449_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
Background Endovascular treatment of wide-necked bifurcation aneurysms remains challenging. Although the advent of PulseRider and Web has expanded treatment options, aneurysms with a large deviation from the parent artery axis remains difficult to treat. We present the case of a wide-necked bifurcation aneurysm that was misaligned with the angle between the long axis of the parent artery and the aneurysm and was successfully treated with Y-shaped PulseRider-assisted coil embolization. Case Description A 64-year-old woman presented with an unruptured basilar tip aneurysm. Cerebral angiography showed a wide-necked aneurysm measuring 8.1 mm × 6.1 mm, neck 5.7 mm. The aneurysm was strongly tilted to the right and posterior relative to the basilar artery, and the bilateral posterior cerebral artery (PCA) and superior cerebellar artery (SCA) diverged from the aneurysm body. PulseRider-assisted coil embolization was performed. A Y-shaped PulseRider was selected to be placed in a hybrid fashion with the right arch in the aneurysm and the left arch in the branch. Adequate coil embolization with preservation of the bilateral PCA and SCA was possible, and cerebral angiography immediately after the treatment showed slight dome filling. Cerebral angiography 6 months after the procedure showed that the embolic status had improved to complete occlusion. Conclusion For wide-neck bifurcation aneurysms with a misaligned axis, a Y-shaped PulseRider used in a hybrid fashion, in which the leaflet on the side with the tilted axis is placed in the aneurysm, allows the PulseRider to be deployed more closely to the aneurysm, thereby enabling good coil embolization.
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Affiliation(s)
- Kohei Shibuya
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
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3
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Colasurdo M, Edhayan G, Al Taweel A, Barghash M, Kan P, Raghuram K. The Rationale Behind Transcirculation Neuroendovascular Interventions: Literature Review Through a Case-Series Approach. Oper Neurosurg (Hagerstown) 2023; 24:357-367. [PMID: 36701756 DOI: 10.1227/ons.0000000000000540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/20/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND With the development of advanced endovascular techniques and materials, neurointerventionalists can perform challenging and complex cases that were previously difficult to perform. Transcirculation approaches could be a useful tool used in complicated cases, providing access to the target vessel, through the contralateral or opposite circulation, when anterograde access is difficult or nonachievable. OBJECTIVE To retrospectively review cerebrovascular interventions performed through a transcirculation approach performed by staff at our Institution. METHODS English-language studies, published until August 2022, reporting transcirculation interventions in the cerebrovascular circulation were retrospectively collected. Type of intervention, number of cases, rationale, and complications were analyzed. Furthermore, similar cases performed by staff currently at our institution were also reviewed and described. RESULTS Including our cases, a total of 273 transcirculation treatment approaches have been reported. Intracranial aneurysm embolization, stroke thrombectomies, intra-arterial ophthalmic chemotherapy, arteriovenous malformationss, arteriovenous fistulas embolizations, and intracranial angioplasty and stenting are common indications. Reason for using a retrograde approach were stent/balloon-assisted coiling of wide neck aneurysm in 116 cases, difficult angulation of branch in 91 cases, occlusion of parent vessel in 55 cases, and bailout/other in 11 cases. CONCLUSION Transcirculation approaches can be considered for cases where conventional anterograde treatment options are not feasible or as a bailout strategy in failed or complicated treatment attempts. They represent a strategy to consider when facing challenging cases, and if performed by experienced and dedicated neurointerventionalists, they can represent a safe alternative.
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Affiliation(s)
- Marco Colasurdo
- Department of Radiology, Division of Neuroradiology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Gautam Edhayan
- Department of Radiology, Division of Neuroradiology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Alaha Al Taweel
- Department of Radiology, Division of Neuroradiology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Maggie Barghash
- Department of Radiology, Division of Neuroradiology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Karthikram Raghuram
- Department of Radiology, Division of Neuroradiology, The University of Texas Medical Branch, Galveston, Texas, USA
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4
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PulseRider-assisted coil embolization for an unruptured internal carotid artery-persistent primitive trigeminal artery aneurysm. J Stroke Cerebrovasc Dis 2023; 32:106876. [PMID: 36470175 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 12/04/2022] Open
Abstract
A persistent primitive trigeminal artery (PPTA) is a vessel remnant of carotid-vertebrobasilar anastomosis. The aneurysm at the bifurcation of the internal carotid artery (ICA) and PPTA tends to have a broad neck with the branch incorporated into the sac. Because PPTA supplies to the posterior circulation and branches off direct pontine perforators, PPTA preservation should always be considered when treating PPTA aneurysms to avoid ischemic complications.We report a case of the wide-neck ICA-PPTA aneurysm successfully treated with the PulseRider-assisted coil embolization, resulting in complete occlusion with PPTA patency. Relevant anatomy and endovascular strategy of the PPTA aneurysms are discussed.
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Lauzier DC, Huguenard AL, Srienc AI, Cler SJ, Osbun JW, Chatterjee AR, Vellimana AK, Kansagra AP, Derdeyn CP, Cross DT, Moran CJ. A review of technological innovations leading to modern endovascular brain aneurysm treatment. Front Neurol 2023; 14:1156887. [PMID: 37114225 PMCID: PMC10126349 DOI: 10.3389/fneur.2023.1156887] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Tools and techniques utilized in endovascular brain aneurysm treatment have undergone rapid evolution in recent decades. These technique and device-level innovations have allowed for treatment of highly complex intracranial aneurysms and improved patient outcomes. We review the major innovations within neurointervention that have led to the current state of brain aneurysm treatment.
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Affiliation(s)
- David C. Lauzier
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- *Correspondence: David C. Lauzier ;
| | - Anna L. Huguenard
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Anja I. Srienc
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Samuel J. Cler
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Joshua W. Osbun
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Arindam R. Chatterjee
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Ananth K. Vellimana
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Akash P. Kansagra
- Department of Neurointerventional Surgery, California Center of Neurointerventional Surgery, San Diego, CA, United States
| | - Colin P. Derdeyn
- Department of Radiology, University of Iowa School of Medicine, Iowa City, IA, United States
| | - Dewitte T. Cross
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Christopher J. Moran
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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6
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Horizontal stent deployment via extracranial-intracranial bypass in coil embolization of basilar apex aneurysms: technical report. Acta Neurochir (Wien) 2022; 164:1281-1285. [PMID: 34817629 DOI: 10.1007/s00701-021-05070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The endovascular treatment of large, wide-necked basilar apex aneurysms (BAAs) remains challenging. Although horizontal stent deployment across both P1 segments of the posterior cerebral arteries (PCAs) would be an optimal strategy in coil embolization of wide-necked BAAs, this is only feasible in cases with anatomically favorable access. In rare circumstances, large-diameter conduits of extracranial-intracranial (EC-IC) bypass can also provide a good access route for endovascular treatment of complex intracranial aneurysms. METHODS We describe the technique of accessing the PCA via EC-IC bypass grafts and deploying a stent horizontally across the neck of BAA and its coil embolization. We provide a detailed technical review and describe some pitfalls of the procedure. RESULTS Two patients underwent EC-IC bypass surgery prior to the treatment of a large, wide-necked BAA. The radial artery and saphenous vein were used as grafts, respectively. To facilitate coil embolization for a large BAA, a PCA-to-PCA horizontal stent was deployed via the bypass graft. Trans-cell and jailing techniques were used, respectively. Both aneurysms were completely occluded, and the patients were discharged without any neurological deficit. CONCLUSION Horizontal stent deployment via EC-IC bypass grafts can be performed safely, providing proper closure of the aneurysmal neck and apposition to both PCAs, facilitating complete coil embolization.
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7
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Mascitelli JR, Levitt MR, Griessenauer CJ, Kim LJ, Gross B, Abla A, Winkler E, Jankowitz B, Grandhi R, Goren O, Schirmer CM. Transcirculation approach for stent-assisted coiling of intracranial aneurysms: a multicenter study. J Neurointerv Surg 2020; 13:711-715. [PMID: 33203763 DOI: 10.1136/neurintsurg-2020-016899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The transcirculation approach (TCA) for stent-assisted coiling (SAC) of intracranial aneurysms may be useful for certain wide-neck bifurcation aneurysms as well as those with acute-angle efferent branches. OBJECTIVE To describe a multicenter experience using the TCA for SAC. METHODS A multicenter, retrospective study (2016-2020) of aneurysm treatment using SAC via the TCA. Angiographic outcome was scored using the Raymond Scale (adequate occlusion 1 and 2), and clinical outcome was scored using a modified Rankin Scale (good outcome 0-2) RESULTS: Twenty-nine patients with 29 aneurysms were included (62.1% female; average age 61; 89.7% unruptured; 13.8% previously treated; average dome size 6.4 mm; average neck 4.4 mm). Aneurysm locations included internal carotid artery-fetal posterior cerebral artery (n=4), internal carotid artery terminus (n=4), anterior communicating artery (n=8), vertebral artery-posterior inferior cerebellar artery (n=2), and basilar tip (n=11). The TCA used communicating arteries (93.1%; average 1.6 mm), intermediate catheters (51.7%), jailing technique (62.1%), and staged procedures (10.3%). The most common stent was the Neuroform Atlas (Stryker; 69%). Immediate adequate occlusion was obtained in 75.9%, and five patients with inadequate occlusion progressed to adequate occlusion at follow-up. One (3.4%) procedural complication occurred: a watershed stroke in the setting of baseline four-vessel extracranial disease. Two patients had a poor outcome unrelated to the TCA. The majority of patients (86.4%) had a good clinical outcome. One case of in-stent stenosis due to non-compliance with medication was seen, which resolved with medication resumption. CONCLUSIONS The TCA for SAC can be performed for a variety of aneurysms with a low complication rate and good clinical outcomes.
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Affiliation(s)
- Justin R Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Michael R Levitt
- Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger Health System, Danville, PA, USA.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Louis J Kim
- Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Bradley Gross
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Adib Abla
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Ethan Winkler
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Brian Jankowitz
- Department of Neurosurgery, Cooper University Health Care, Camden, NJ, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Oded Goren
- Department of Neurosurgery, Geisinger Health System, Danville, PA, USA
| | - Clemens M Schirmer
- Department of Neurosurgery, Geisinger Health System, Danville, PA, USA.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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Basilar Apex Aneurysm: Case Series, Systematic Review, and Meta-analysis. World Neurosurg 2020; 138:e183-e190. [DOI: 10.1016/j.wneu.2020.02.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 11/21/2022]
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9
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Roa JA, Maud A, Jabbour P, Dabus G, Pazour A, Dandapat S, Ortega-Gutierrez S, Paez-Granda D, Kalousek V, Hasan DM, Samaniego EA. Transcirculation Approach for Mechanical Thrombectomy in Acute Ischemic Stroke: A Multicenter Study and Review of the Literature. Front Neurol 2020; 11:347. [PMID: 32457691 PMCID: PMC7221059 DOI: 10.3389/fneur.2020.00347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Transcirculation approaches, which consist of primary catheterization of a target artery from the contralateral side or opposite cerebral circulation, provide alternate endovascular routes when anterograde interventions are not feasible. We aimed to assess the safety and efficacy of mechanical thrombectomy (MT) through a transcirculation route. Methods: Six centers provided retrospective data on acute ischemic stroke (AIS) patients who underwent MT via transcirculation approaches. Demographics and technical details of the endovascular intervention were collected. Recanalization rates, peri-procedural complications and clinical/angiographic outcomes immediately after the procedure and at last available follow-up were assessed. A review of the literature reporting on AIS patients whom underwent transcirculation MT was also performed. Results: Our multicenter study included 14 AIS patients treated through transcirculation routes. Mean age was 57.8 ± 11.9 years, and 10 (71.4%) were men. Mean NIHSS at admission was 18.4 (range 8–27). TICI 2b-3 recanalization was achieved in 10/14 (71.4%) patients. Three patients died after intervention: one due to late recanalization, one due to acute in-stent thrombosis, and one due to a procedure-related thromboembolic brainstem infarct. Of 11 surviving patients with follow-up available (mean 9.7 months), mRS 0–2 was achieved in 6 (54.5%) cases. Our review of the literature pooled a total of 37 transcirculation MT cases. Most common occlusions were tandem lesions (ICA + MCA = 64.9%) and BA + bilateral VA (18.9%). ACOM and PCOM were crossed in 18 (48.6%) cases each; one patient required a combined ACOM-PCOM approach. Primary recanalization technique included intra-arterial (IA) thrombolytics alone in 10 (27%), angioplasty ± stenting in 6 (16.2%), stent-retriever in 8 (21.6%), contact aspiration in 6, and combined (MT ± IA-thrombolytics) in 6 cases. Twenty-eight (75.7%) AIS patients achieved successful TIMI 2-3/TICI 2b-3 recanalization. After a mean follow-up of 6.7 months, 23/31 (74.2%) patients achieved a favorable functional outcome. Conclusions: Transcirculation approaches may be used to access the target lesion when the parent artery cannot be crossed through conventional antegrade routes. These techniques are feasible but should be reserved as a bailout maneuver when anterograde MT is not possible. Newer endovascular devices have improved neurological and angiographic outcomes in transcirculation cases.
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Affiliation(s)
- Jorge A Roa
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Alberto Maud
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United States
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | - Guilherme Dabus
- Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, United States
| | - Avery Pazour
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Sudeepta Dandapat
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Santiago Ortega-Gutierrez
- Departments of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Diego Paez-Granda
- Department of Radiology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Vladimir Kalousek
- Department of Neurology, University Clinical Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - David M Hasan
- Departments of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Edgar A Samaniego
- Departments of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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Roa JA, Ortega-Gutierrez S, Martinez-Galdamez M, Maud A, Dabus G, Pazour A, Dandapat S, Arteaga MS, Fernandez JG, Paez-Granda D, Kalousek V, Pons RB, Mowla A, Duckwiler G, Szeder V, Jabbour P, Hasan DM, Samaniego EA. Transcirculation Approach for Endovascular Embolization of Intracranial Aneurysms, Arteriovenous Malformations, and Dural Fistulas: A Multicenter Study. World Neurosurg 2020; 134:e1015-e1027. [DOI: 10.1016/j.wneu.2019.11.078] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 11/25/2022]
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Lesley WS, Lyon K. Basilar tip aneurysm Wingspan stent-assisted coil embosurgery via P1 to P1 approach. Proc (Bayl Univ Med Cent) 2020; 33:87-89. [DOI: 10.1080/08998280.2019.1673921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 10/19/2022] Open
Affiliation(s)
- Walter S. Lesley
- Department of Neurosurgery, Baylor Scott and White Medical Center, Temple, Texas
| | - Kristopher Lyon
- Department of Neurosurgery, Baylor Scott and White Medical Center, Temple, Texas
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12
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Park KY, Jang CK, Lee JW, Kim DJ, Kim BM, Chung J. Preliminary experience of stent-assisted coiling of wide-necked intracranial aneurysms with a single microcatheter. BMC Neurol 2019; 19:245. [PMID: 31640586 PMCID: PMC6806571 DOI: 10.1186/s12883-019-1470-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to report our preliminary experience of stent-assisted coiling (SAC) of wide-necked intracranial aneurysms with a single microcatheter in patients with parent arteries that were small-caliber, with stenosis, or a very tortuous course. METHODS Between March 2018 and December 2018, we treated 394 aneurysms in 359 patients with endovascular treatment. Among 197 aneurysms treated by SAC, there were 16 cases (all wide-necked unruptured aneurysms) treated by SAC with a single microcatheter and a Neuroform Atlas stent. Follow-up angiography was performed at 6 to 12 months after SAC, and clinical follow-up was performed from 6 to 12 months in all patients. RESULTS The reasons for SAC with a single 0.0165-in. microcatheter were small-caliber (n = 4), stenosis (n = 2), and very tortuous course (n = 10) of the parent arteries. There was no complication related to delivering or deploying the Neuroform Atlas stent as well as no failure of selecting aneurysm by cell-through technique. All patients had a modified Rankin score of 0 at discharge and at follow-up. Initial angiographic results showed six cases (37.5%) of complete occlusion. In follow-up angiographies, 12 cases (75.0%) achieved compete occlusion. CONCLUSION When performing SAC of wide-necked intracranial aneurysms in parent arteries with small-caliber, stenosis, or a very tortuous course, cell-through SAC using a single microcatheter and a Neuroform Atlas stent within a 5 Fr- (or smaller) guiding or intermediate catheter might be a useful option.
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Affiliation(s)
- Keun Young Park
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Chang Ki Jang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jae Whan Lee
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Dong Joon Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Moon Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. .,Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Dornbos D, Khandpur U, Youssef PP. T-Configuration Horizontal Low-Profile Visualized Intraluminal Support (LVIS Jr) Device-Assisted Coiling for Treatment of Basilar Tip Aneurysms: A Technical Note. World Neurosurg 2019; 129:428-431. [PMID: 31158535 DOI: 10.1016/j.wneu.2019.05.220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Provided certain anatomic considerations, stent-assisted coiling of basilar apex aneurysms can be performed using a single stent placed in a horizontal T-configuration across the aneurysm neck prior to coil deployment, although this has predominantly been described using older-generation stents. The development of the Low-profile Visualized Intraluminal Support (LVIS Jr) device has provided greater versatility than previous stents, including use in smaller vessels, the ability to be resheathed, and improved flow diversion properties. METHODS To our knowledge, we report the first use of the LVIS Jr device in a horizontal T-configuration across the aneurysm neck prior to coil deployment in 2 patients for the treatment of basilar apex aneurysms. This technique requires robust posterior communicating artery aneurysms and a second site of vascular access. RESULTS Both patients demonstrated good outcomes following the procedure with no adverse sequelae. One patient required retreatment for recurrence after 1 year and was able to undergo further coiling without difficulty. CONCLUSIONS Use of the LVIS Jr device allows greater versatility in horizontal T-configuration stent-assisted coil embolization, when compared with other available intracranial stents. This provides another tool to treat basilar apex aneurysms with improved coil occlusion and a theoretically decreased risk of thromboembolic events.
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Affiliation(s)
- David Dornbos
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Umang Khandpur
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Patrick P Youssef
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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14
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Kwon HJ, Cho YD, Lim JW, Koh HS, Yoo DH, Kang HS, Han MH. Contralateral Approach to Coil Embolization of Proximal A1 Aneurysms Using the Anterior Communicating Artery. AJNR Am J Neuroradiol 2018; 39:2297-2300. [PMID: 30442700 DOI: 10.3174/ajnr.a5875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/28/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Aneurysms arising from the proximal A1 segment of the anterior cerebral artery are rare, and their distinctive configurations often pose technical challenges during endovascular embolization. Herein, we present 11 patients with proximal A1 aneurysms requiring a contralateral approach (via the anterior communicating artery) to coil embolization. MATERIALS AND METHODS From a prospectively collected data repository, we retrieved records of 11 patients consecutively treated for proximal A1 aneurysms between January 2011 and March 2018. In each instance, coil embolization was performed by the contralateral route. Outcomes were analyzed in terms of morphologic features and clinical status. RESULTS Aneurysms in all 11 patients were directed posteriorly and were small (<5 mm). A contralateral approach (via the anterior communicating artery) was used after ipsilateral attempts at aneurysm selection failed in each instance, despite using a variety of microcatheters. Single punctures and single guiding catheters sufficed in 9 patients, but 2 patients required dual punctures and 2 guiding catheters. All endovascular treatments ultimately yielded excellent outcomes. Although 1 symptomatic infarct was manifested in the course of ipsilateral treatment, no morbidity or mortality resulted from the contralateral access. CONCLUSIONS Due to angio-anatomic constraints, a contralateral strategy for coil embolization of proximal A1 aneurysms is acceptable if ipsilateral access is technically prohibitive and the vessels (contralateral A1 and anterior communicating artery) are amenable to the passage of microdevices.
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Affiliation(s)
- H-J Kwon
- From the Department of Neurosurgery (H.-J.K., J.W.L., H.-S. Koh), Regional Cerebrovascular Center, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Y D Cho
- Departments of Radiology (Y.D.C., D.H.Y., M.H.H.)
| | - J W Lim
- From the Department of Neurosurgery (H.-J.K., J.W.L., H.-S. Koh), Regional Cerebrovascular Center, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - H-S Koh
- From the Department of Neurosurgery (H.-J.K., J.W.L., H.-S. Koh), Regional Cerebrovascular Center, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - D H Yoo
- Departments of Radiology (Y.D.C., D.H.Y., M.H.H.)
| | - H-S Kang
- Neurosurgery (H.-S. Kang), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - M H Han
- Departments of Radiology (Y.D.C., D.H.Y., M.H.H.)
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Jeon HJ, Park JH, Lee JY, Jeon HJ, Park SW, Cho BM. Endovascular Coiling for a Wide-neck Bifurcated Aneurysm with Anterograde Horizontal Stenting via Microcatheter Looping: A Technical Case Report. J Cerebrovasc Endovasc Neurosurg 2018; 20:181-186. [PMID: 30397590 PMCID: PMC6199400 DOI: 10.7461/jcen.2018.20.3.181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/05/2018] [Accepted: 09/14/2018] [Indexed: 11/23/2022] Open
Abstract
Technical advances with devices such as catheters, balloons, and stents have widened the indications for endovascular coiling for unfavorable aneurysms. The authors report two cases of coil embolization for a wide-neck bifurcated aneurysm with anterograde horizontal stenting via microcatheter looping. Two women, aged 56 and 38 years, respectively, had an undertall- and overwide-neck aneurysm with bifurcated branches at the basilar bifurcation and middle cerebral bifurcation, respectively. The delivery microcatheter was steamed so that it could be looped deliberately to the opposite vessel. The enterprise stent was first anchored to the vessel of the posterior cerebral artery on one side. The remaining portion was spanned into a looped microcatheter to the opposite branch while pushing the stent. The Neuroform Atlas stent was passed directly through the looped segment of the microcatheter at the M2 branch and spanned horizontally by unsheathing. Under horizontal stenting, complete coil embolization was achieved without immediate or delayed complications in both cases. This novel technique presents a viable option for stent-assisted coiling within an optimal anatomy.
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Affiliation(s)
- Hyun-Jae Jeon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Hwa Park
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Gangwon National University College of Medicine, Chuncheon, Korea
| | - Jong-Young Lee
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hong-Jun Jeon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Gangwon National University College of Medicine, Chuncheon, Korea
| | - Seoung-Woo Park
- Department of Neurosurgery, Gangwon National University College of Medicine, Chuncheon, Korea
| | - Byung-Moon Cho
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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16
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Kim YJ, Sung JH, Hong JT, Lee SW. Horizontal Stent Assisted Coiling of Wide Neck Basilar Tip Aneurysm: Comparison of Two Cases. J Cerebrovasc Endovasc Neurosurg 2017; 19:201-206. [PMID: 29159154 PMCID: PMC5680084 DOI: 10.7461/jcen.2017.19.3.201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 09/21/2017] [Accepted: 09/28/2017] [Indexed: 11/23/2022] Open
Abstract
Currently, endovascular coiling is a popular treatment for basilar tip aneurysms, which usually involve a wide neck. Serious complications can occur when the posterior cerebral artery (PCA) originating from a wide neck is not properly preserved. Accordingly, various adjunctive procedures using stents or a balloon have been introduced. Herein we report two cases of basilar tip aneurysms in which retrograde horizontal (from one PCA to the other PCA) stent-assisted coiling was successful, and we provide a summary of the important technical points.
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Affiliation(s)
- Young Jin Kim
- Department of Neurosurgery, Cheongju St. Mary's Hospital, The Catholic University of Korea, Cheongju, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Sang Won Lee
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
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17
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Kitahara T, Hatano T, Hayase M, Hattori E, Miyakoshi A, Nakamura T. Jailed double-microcatheter technique following horizontal stenting for coil embolization of intracranial wide-necked bifurcation aneurysms: A technical report of two cases. Interv Neuroradiol 2017; 23:117-122. [PMID: 28304199 DOI: 10.1177/1591019916685080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The horizontal stenting technique facilitates endovascular treatment of wide-necked bifurcation intracranial aneurysms. Previous literature shows, however, that subsequent coil embolization at initial treatment results in incomplete obliteration in many cases. The authors present two consecutive cases of wide-necked large bifurcation aneurysms to describe an additional coil embolization technique following horizontal stenting. The patients were a 53-year-old female with an unruptured internal carotid artery terminus aneurysm and a 57-year-old female with a recurrent basilar artery tip aneurysm. Both patients underwent endovascular treatment with horizontal stenting followed by coil embolization with jailed double-microcatheters. Immediate complete obliteration was achieved with no complications, and no recanalization was observed at the one-year follow-up in both cases. Coil embolization with jailed double-microcatheter technique following horizontal stenting is a safe and effective strategy for wide-necked bifurcation aneurysms.
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Affiliation(s)
| | - Taketo Hatano
- Department of Neurosurgery, Fukui Red Cross Hospital, Japan
| | - Makoto Hayase
- Department of Neurosurgery, Fukui Red Cross Hospital, Japan
| | - Etsuko Hattori
- Department of Neurosurgery, Fukui Red Cross Hospital, Japan
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18
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Yang ZG, Liu J, Ge J, Li ZF, Tian CO, Han J, Zhao R, Hong B. A novel proximal end stenting technique for assisting embolization of a complex true posterior communicating aneurysm. J Clin Neurosci 2016; 28:148-51. [PMID: 26906925 DOI: 10.1016/j.jocn.2015.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/14/2015] [Accepted: 09/19/2015] [Indexed: 11/17/2022]
Abstract
Stent-assisted coiling has been widely used for endovascular treatment in recent years with satisfying clinical outcomes. The implantation of a stent using the regular approach, however, may not be safe or effective for certain aneurysms with complex structures. In this study, we report a novel stenting technique utilizing the proximal end of the stent for assisting embolization of a wide-neck irregular true posterior communicating aneurysm. This new method is a potential treatment strategy for wide-neck aneurysms located at the origin of a tortuous and thin vessel.
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Affiliation(s)
- Zhi-Gang Yang
- Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
| | - Jianmin Liu
- Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
| | - Jiajia Ge
- Siemens Ltd. China, Healthcare Sector, Angiography & Interventional X-ray Systems, China
| | - Zi-Fu Li
- Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
| | - Chun-Ou Tian
- Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
| | - Jingfeng Han
- Siemens Ltd. China, Healthcare Sector, Angiography & Interventional X-ray Systems, China
| | - Rui Zhao
- Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
| | - Bo Hong
- Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China.
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19
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Trivelato F, Araújo J, Salles Rezende M, Ulhôa A. A Novel Configuration of Pipeline Embolization Device for Internal Carotid Bifurcation Region Aneurysms: Horizontal Deployment. Clin Neuroradiol 2015; 27:57-60. [DOI: 10.1007/s00062-015-0414-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/15/2015] [Indexed: 11/30/2022]
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20
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Kim YJ, Ko JH. Coiling of a recurrent broad-necked posterior communicating aneurysm incorporating a fetal cerebral artery: A technical case report. Interv Neuroradiol 2015; 21:44-9. [PMID: 25934774 DOI: 10.15274/inr-2014-10088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We describe a case of a right broad-necked posterior communicating artery (PcomA) aneurysm with a fetal posterior cerebral artery (PCA) incorporated in the aneurysm neck. We performed waffle cone stent-assisted coiling and achieved almost complete occlusion of the aneurysm. At 18-month follow-up angiography, the aneurysm was recanalized and further coiling was needed. The same waffle cone method of coiling might be expected to produce the same unsatisfactory results on follow-up, so we decided to use retrograde stent navigation and placement through the anterior communicating artery (AcomA) from the contralateral internal carotid artery (ICA) to the ipsilateral ICA and fetal PCA. The stent delivery microcatheter from the contralateral ICA could not be introduced in the AcomA. So 2 mg nimodipine was infused through the stent delivery microcatheter to the AcomA and the stent delivery microcatheter was passed through the AcomA easily and could be navigated to the ipsilateral A1, ICA, and to the fetal PCA. With this additional stent, the aneurysm was completely separated from the fetal PCA and ICA. Further coiling could be performed safely through the microcatheter in the ipsilateral ICA. The patient had stable aneurysm occlusion at the six-month follow up.
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Affiliation(s)
- Young-Joon Kim
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jung Ho Ko
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
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21
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Kim YJ, Ho Ko J. Coiling of a recurrent broad-necked posterior communicating aneurysm incorporating a fetal cerebral artery: A technical case report. Interv Neuroradiol 2015. [DOI: 10.1177/inr-2014-10088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Abstract
Introduction:Endovascular coiling of aneurysms crossing the Circle of Willis has been described in small case series. The technical challenges in manipulating a stent across the Circle of Willis lie in negotiating difficult angles and small arteries. We present our experience with treating aneurysms by stent assistance in which the Circle of Willis was crossed to facilitate optimal stent deployment.Materials and methods:We retrospectively reviewed the cases in our institution from January 2009 to June 2012 in which the Circle of Willis was traversed to facilitate optimal stent deployment. We measured the diameter of the communicating arteries traversed, caliber of the target arteries in which the stent was deployed and the most acute angle negotiated (“critical angle”). We compare our results with other published series in the literature.Results:Eight patients fulfilled the criteria: 5 males (45-66 years). There were three anterior and five posterior circulation aneurysms. Four of the aneurysms were ruptured. The PCOM was traversed in five cases, the ACOM in three cases. The mean diameter of the communicating artery was 1.17mm. The mean diameter of target arteries was 1.27mm. The “critical angle” was 72-147 degrees. In all patients, there was satisfactory obliteration of the aneurysm. There were two cases of minor SAH post procedure.Conclusion:Utilizing the Circle of Willis for optimal stent placement in aneurysm remodeling is technically feasible but challenging. This technique can be performed successfully in patients with acute SAH. The procedural risk must be balanced against potential complications such as SAH.
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Zhang JZ, Yang PF, Huang QH, Xu Y, Hong B, Zhao WY, Liu JM. Stent-assisted coiling strategies for the treatment of wide-necked basilar artery bifurcation aneurysms. J Clin Neurosci 2014; 21:962-7. [DOI: 10.1016/j.jocn.2013.08.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 08/21/2013] [Accepted: 08/31/2013] [Indexed: 11/30/2022]
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Cho YD, Kim KM, Lee WJ, Kang HS, Kim JE, Han MH. Retrograde stenting through the posterior cerebral artery in coil embolization of the posterior communicating artery aneurysm. Neuroradiology 2013; 55:733-9. [DOI: 10.1007/s00234-013-1163-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/27/2013] [Indexed: 10/27/2022]
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