Trans-Cell Technique through Mesh of Pipeline Embolization Device: A Case Report

Abstract

We report a case of coil embolization using trans-cell technique through mesh of a pipeline embolization device (PED). Case Presentation: A 55-year-old female developed a left cavernous carotid aneurysm (CCA) with left abducens nerve palsy. The abducens nerve palsy improved gradually after PED deployment for the aneurysm. Sixty-nine days after the procedure, the patient suddenly presented with a severe headache, left abducens nerve palsy, left eyelid edema, and left pulsatile tinnitus. Digital subtraction angiography (DSA) revealed left direct carotid cavernous fistula (dCCF) due to rupture of the aneurysm, and the patient underwent endovascular treatment. A Marathon was guided into the left internal carotid artery, and a guidewire via the Marathon passed through the mesh of the PED. Then the Marathon advanced over the guidewire into the aneurysm through the mesh of the PED, with assistance of a distal access catheter and a balloon catheter. Transarterial intra-aneurysmal coil embolization using trans-cell technique was performed, and the shunt blood flow was diminished. After subsequent transvenous embolization (TVE), the shunt blood flow disappeared, and all neurological symptoms improved. When PED is deployed linearly at a diameter 0.5 mm smaller than the nominal diameter, the average strand spacing is calculated to be approximately 0.2 mm. Since PED is a braided stent, the spacing can be large. It is theoretically reasonable for Marathon with an outer diameter of 0.59 mm to pass through the mesh of the PED. Conclusion: In some cases, trans-cell technique through mesh of PED can be performed using a small diameter microcatheter. Keywords▶ pipeline embolization device, trans-cell technique through mesh of flow diverter, coil embolization through Marathon, cavernous carotid aneurysm, direct carotid cavernous fistula This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

Coil Embolization of Unruptured Distal Anterior Cerebral Artery Aneurysm Using a Marathon Microcatheter

“…They also reported that during stent-assisted coil embolization for an aneurysm in the tip of the ICA, the trans-cell technique with Marathon was easy because Marathon had a small diameter. Sonobe et al reported that the small diameter of Marathon allowed the trans-cell technique to be used for ruptured case of intracavernous sinus carotid artery aneurysm after placement of a flow diverter [ 3 ]. Uyama et al reported that during stent-assisted coil embolization of the ICA-posterior communicating artery aneurysm, the small diameter of Marathon made it easier to pass through a stented posterior communicating artery and perform the trans-cell technique [ 5 ].…”