Microguidewire Looping to Traverse Stented Parent Arteries of Intracranial Aneurysms

Abstract

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.

Visualization of stent apposition after stent-assisted coiling of intracranial aneurysms using high resolution 3D fusion images acquired by C-arm CT

“…These factors should be recognized for patients treated by stent-assisted coiling, 13 as both types of incomplete malapposition can interfere with the maneuverability of the guidewires or microcatheters through the stents. 4 Our study could thus confirm the estimated proportions of stent malapposition detected by 3T MRA imaging. 1 For closed cell stents, malapposition was more frequently found at the carotid siphon.…”

“…If malapposition is detected, antiplatelet therapy may need to be adjusted 3. In addition, stent malapposition, especially at the edges of the stent, may disturb the smooth catheterization of the microcatheter tip through the true lumen of the stent during a follow-up treatment 4…”

“…3 In addition, stent malapposition, especially at the edges of the stent, may disturb the smooth catheterization of the microcatheter tip through the true lumen of the stent during a follow-up treatment. 4 Stent apposition is usually evaluated based on a two-dimensional (2D) maximum intensity projection image acquired during the procedure by an angiographic C-arm system after the administration of a low concentration contrast medium. [5][6][7][8] C-arm CT has also been applied with good results for the evaluation of stent apposition during flow diverter stent deployment before stent plasty.…”

A Case of Microguidewire and Neuroform Atlas Stent Entanglement Resulting in Extraction Difficulty

“…It is important to guide the J curve microguidewire into the stent, as described elsewhere. 4 ) However, as in our case, if the J-shaped microguidewire is rotated in the stent, it may become entangled with the stent. Therefore, after guiding the catheter into the stent, it is considered important to change the microguidewire’s shape to allow facilitate its insertion.…”

“…Some reports have described how to perform the transcell technique safely, [4][5][6] but their complications are rarely reported. [7][8][9] In case of the Neuroform Atlas stent and Synchro SELECT entanglement, causing difficulty in removal, severe complications may occur.…”