Microcatheter Looping Technique for Coil Embolization of Complex Configuration Middle Cerebral Artery Aneurysms

Cho, Young Dae; Kang, Hyun Seung; Kim, Jeong Eun; Son, Young Hoon; Lee, Jong‐Young; Lee, Seung Jin; Seo, Jung Hwa; Han, Moon Hee

doi:10.1227/neu.0b013e318271ee1a

Cited by 24 publications

(12 citation statements)

References 12 publications

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“…Device improvements and advances in coiling techniques have now enabled treatment of lesions with complex configurations3,18). Stenting (and various modifications thereof) has contributed greatly in this context, broadening the scope of endovascular treatment substantially5,7,10,12,14–19,21).…”

Section: Introductionmentioning

confidence: 99%

Microguidewire Looping to Traverse Stented Parent Arteries of Intracranial Aneurysms

Cho

Rhim

Yoo

et al. 2017

J Korean Neurosurg Soc

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ObjectiveStents 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.MethodsTo 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.ResultsThis 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.ConclusionMicroguidewire looping is a reasonable alternative if passage through a stented artery is not feasible by traditional means, especially at paraclinoid ICA sites.

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Section: Introductionmentioning

confidence: 99%

Microguidewire Looping to Traverse Stented Parent Arteries of Intracranial Aneurysms

Cho

Rhim

Yoo

et al. 2017

J Korean Neurosurg Soc

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“…In the present two cases, we performed coil embolization after horizontal deployment of Enterprise and Neuroform Atlas stents by using an antegrade approach for the BABIF and MCBIF aneurysms via a catheter looping technique. 4) As a retrograde route is not guaranteed, some important points have to be considered in anterograde stent deployment. First, the diameters of the efferent vessels on both sides should provide sufficient space to enable looping and maneuvering of the delivery microcatheter as noted in previous technical notes.…”

Section: Discussionmentioning

confidence: 99%

“…The rapid development of additional devices and techniques for endovascular coiling has practically allowed treatment of more complex aneurysms that seem to have unfavorable anatomies. 4) 9) 10) 14) However, wide-neck bifurcated aneurysms cannot be favorably protected by an additional device such as a balloon or stent and a multi-catheter. Although Y-stenting or waffle cone stent-assisted coiling has been precisely developed to cover a whole range of aneurysm neck, it has an increased risk of thromboembolism or reduced completeness of occlusion.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Coiling for a Wide-neck Bifurcated Aneurysm with Anterograde Horizontal Stenting via Microcatheter Looping: A Technical Case Report

Jeon

Park

Lee

et al. 2018

J Cerebrovasc Endovasc Neurosurg

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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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“…The first step of this technique is identifying proper microcatheter shape, according to type of aneurysm and direction of dome ( Table 2 ). The process of making a loop of a microcatheter tip, as next step, is reported elsewhere ( 7 13 ). The looping generally is achieved without great difficulty under the following conditions: 1) the microcatheter passes through carotid siphon; 2) microcatheter advances under the guidance of looped microguidewire between cervical ICA and cavernous ICA; and 3) guiding catheter moves from distal common carotid artery to proximal ICA (with microcatheter placed in proximal external carotid artery).…”

Section: Methodsmentioning

confidence: 99%

“…Endovascular coil embolization has been widely employed for the treatment of intracranial aneurysms since the International Subarachnoid Aneurysm Trial and the International Study of Unruptured Intracranial Aneurysms ( 3 4 5 6 ). Recently, improved protection devices and advanced coiling techniques, such as balloon remodeling and stenting, have enabled coil embolization of aneurysms with complex configurations ( 7 8 9 10 11 ). However, the distinctive angio-anatomic configurations of paraclinoid aneurysms continue to challenge coil embolization ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Microcatheter Looping to Facilitate Aneurysm Selection in Coil Embolization of Paraclinoid Aneurysms

et al. 2015

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ObjectiveDescribed herein is a microcatheter looping technique to facilitate aneurysm selection in paraclinoid aneurysms, which remains to be technically challenging due to the inherent complexity of regional anatomy.Materials and MethodsThis retrospective study was approved by our Institutional Review Board, and informed consent was waived. Microcatheter looping method was employed in 59 patients with paraclinoid aneurysms between January 2012 and December 2013. In the described technique, construction of a microcatheter loop, which is steam-shaped or pre-shaped, based on the direction of aneurysms, is mandatory. The looped tip of microcatheter was advanced into distal internal carotid artery and positioned atop the target aneurysm. By steering the loop (via inner microguidewire) into the dome of aneurysm and easing tension on the microcatheter, the aneurysm was selected. Clinical and morphologic outcomes were assessed with emphasis on technical aspects of the treatment.ResultsThrough this looping technique, a total of 59 paraclinoid aneurysms were successfully treated. After aneurysm selection as described, single microcatheter technique (n = 25) was most commonly used to facilitate coiling, followed by balloon protection (n = 21), stent protection (n = 7), multiple microcatheters (n = 3), and stent/balloon combination (n = 3). Satisfactory aneurysmal occlusion was achieved through coil embolization in 44 lesions (74.6%). During follow-up of 53 patients (mean interval, 10.9 ± 5.9 months), only one instance (1.9%) of major recanalization was observed. There were no complications related to microcatheter looping.ConclusionThis microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail.

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Microcatheter Looping Technique for Coil Embolization of Complex Configuration Middle Cerebral Artery Aneurysms

Abstract: This microcatheter looping technique facilitates safe entry into the distal branch during coil embolization of wide-neck MCA aneurysms incorporating the origins of acutely angulated branches.

Cited by 24 publications

References 12 publications

Microguidewire Looping to Traverse Stented Parent Arteries of Intracranial Aneurysms

Microguidewire Looping to Traverse Stented Parent Arteries of Intracranial Aneurysms

Endovascular Coiling for a Wide-neck Bifurcated Aneurysm with Anterograde Horizontal Stenting via Microcatheter Looping: A Technical Case Report

Microcatheter Looping to Facilitate Aneurysm Selection in Coil Embolization of Paraclinoid Aneurysms

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