A revised stent-retriever anchor technique to obtain the distal access through a large or giant aneurysm

Abstract

Endovascular treatment of brain aneurysms with flow diverter device can be technically difficult. Obtaining distal access through the wide neck of a large or giant aneurysm may be challenging and sometimes the microcatheter needs to be looped inside the aneurysm. However, the inability to resolve this loop and to straighten the microcatheter can preclude flow diverter placement. This brief report presents four cases of large/giant aneurysms treated with flow diverter device, in which our innovative stent-retriever anchor technique was used to obtain the distal access of the parent artery. All procedures were technically successful, and no complications were recorded.

A novel intracranial exchange guidewire improves the navigation of various endovascular devices: An in vitro study of challenging situations

“…The microcatheter tip in the distal parent vessel may be pulled back into the aneurysm dome when attempting to straighten the loop for stent delivery. 2,19 In 2007, Cekirge et al described a balloon anchoring technique in which a Hyperform balloon catheter (Medtronic) was inflated in the distal parent vessel while the wire was gently retracted and the loop straightened. 21 Other balloons have been used for similar techniques, including the Sceptor XC (Microvention Terumo) and the Gateway balloon catheter (Stryker Neurovascular) 1,8 While the use of a balloon may provide adequate support, drawbacks include temporary occlusion of flow, over- straightening of curved segments and potential vessel rupture.…”

“…Giant aneurysms present unique challenges for achieving and maintaining access, including unfavorable angles between the inflow and outflow tracts, flow characteristics, and wide or complex necks. 2,6,7 Previously proposed techniques to maintain access while intra-aneurysmal looping are reduced or while the necessary larger catheters are advanced include balloons, 1,7,9,10 detachable coils, 2 stents, 6,11–16 microwires, 17 stent retrievers, 18,19 and the rapid pull-back technique. 20 In this study, the results suggested that the Stabilizer could be used for multiple techniques while treating a giant aneurysm, including straightening of intra-aneurysmal looping, exchange for a stent delivery catheter, and advancement of an intermediate catheter.…”

“…Several reports described the off-label use of traditional stent retrievers for the exchange of microcatheters in the setting of giant aneurysms. 18,19 The initial navigation through a challenging giant aneurysm is often performed using a flexible guidewire and small microcatheter such as 0.0165 inch inner diameters, but the small microcatheter must be replaced with a larger microcatheter with an 0.027 inner diameter through which a flow diversion stent can be deployed. 19 When a traditional stent retriever is used, special steps must be taken to prevent air embolism when the second microcatheter is introduced because the wire is not long enough to perform a typical exchange maneuver.…”

“…18,19 The initial navigation through a challenging giant aneurysm is often performed using a flexible guidewire and small microcatheter such as 0.0165 inch inner diameters, but the small microcatheter must be replaced with a larger microcatheter with an 0.027 inner diameter through which a flow diversion stent can be deployed. 19 When a traditional stent retriever is used, special steps must be taken to prevent air embolism when the second microcatheter is introduced because the wire is not long enough to perform a typical exchange maneuver. 18 Additionally, when advancing the second microcatheter, the operator does not have control of the stent push wire due to its short length.…”

“…18 Additionally, when advancing the second microcatheter, the operator does not have control of the stent push wire due to its short length. 18,19 These issues are resolved by the 300 cm length of the Stabilizer as it is designed to be used for exchanges. With adequate exchange length, the second microcatheter can be introduced without an increased risk for air embolism, and the operator has control of the exchange wire at all times.…”