Microguidewire Looping to Traverse Stented Parent Arteries of Intracranial Aneurysms.
10.3340/jkns.2016.0707.009
- Author:
Young Dae CHO
1
;
Jong Kook RHIM
;
Dong Hyun YOO
;
Hyun Seung KANG
;
Jeong Eun KIM
;
Moon Hee HAN
Author Information
1. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Aneurysm;
Coil;
Embolization;
Microguidewire;
Stent
- MeSH:
Aneurysm;
Arteries*;
Carotid Arteries;
Embolization, Therapeutic;
Humans;
Intracranial Aneurysm*;
Middle Cerebral Artery;
Mortality;
Neck;
Parents*;
Stents*
- From:Journal of Korean Neurosurgical Society
2017;60(2):262-268
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: Stents are widely used in coil embolization of intracranial aneurysms, but on occasion, a microcatheter must traverse a stented segment of artery (so-called trans-cell technique) to select an aneurysm, or double stenting may necessary. In such situations, microguidewire passage and microcatheter delivery through a tortuous stented parent artery may pose a technical challenge. Described herein is a microguidewire looping technique to facilitate endovascular navigation in these circumstances. METHODS: To apply this technique, the microguidewire tip is looped before entering the stented parent artery and then advanced distally past the stented segment, with the loop intact. Rounding of the tip prevents interference from stent struts during passage. A microcatheter is subsequently passed into the stented artery for positioning near the neck of aneurysm, with microguidewire assistance. The aneurysm is then selected, steering the microcatheter tip (via inner microguidewire) into the dome. RESULTS: This technique proved successful during coil embolization of nine saccular intracranial aneurysms (internal carotid artery [ICA], 6; middle cerebral artery, 2; basilar tip, 1), performing eight trans-cell deliveries and one additional stenting. Selective endovascular embolization was enabled in all patients, resulting in excellent clinical and radiologic outcomes, with no morbidity or mortality directly attributable to microguidewire looping. CONCLUSION: Microguidewire looping is a reasonable alternative if passage through a stented artery is not feasible by traditional means, especially at paraclinoid ICA sites.
