Transcirculation Pipeline embolization device deployment: a rescue technique

Abstract

<jats:p>The Pipeline embolization device (PED) has become a very important tool in the treatment of nonruptured cerebral aneurysms. However, a patient’s difficult anatomy or vascular stenosis may affect the device delivery. The purpose of this article was to describe an alternate technique for PED deployment when ipsilateral anatomy is not amenable for catheter navigation.</jats:p><jats:p>A 44-year-old woman with a symptomatic 6-mm right superior hypophyseal artery aneurysm and a known history of right internal carotid artery dissection presented for PED treatment of her aneurysm. An angiogram showed persistence of the arterial dissection with luminal stenosis after 6 months of dual antiplatelet treatment. The contralateral internal carotid artery was catheterized and the PED was deployed via a transcirculation approach, using the anterior communicating artery. Transcirculation deployment of a PED is a viable option when ipsilateral anatomy is difficult or contraindicated for this treatment.</jats:p>

Microsurgical Treatment of Intracranial Aneurysms: Report of a Series of Cases in a Single Cuban Hospital

“…The results that were obtained in this series, evaluated using the Rankin modified scale, shows the high efficacy of microsurgical treatment for the intracranial aneurysms in our setting in which a big number of patients were discharged without any type of sequelae (74.11%) and the mortality was of 1.76% This way we can conclude that the microsurgical treatment for intracranial aneurisms is a procedure with high rate of efficiency, which represents the principal way of solving a serious health problem for the patients suffering from intracranial aneurisms till when other methods will be disponible to be implemented, such as the endovascular treatment that is widely used in the world [4,5,[18][19][20], for which we already have experience in our country.…”

The Rationale Behind Transcirculation Neuroendovascular Interventions: Literature Review Through a Case-Series Approach

“…Acute angle origin of a vessel is a known, frequently reported, anatomic feature that can result in difficult or even unachievable catheterization. 1,3 When the angle of origin of a vessel proves difficult to catheterize, common techniques used include reshaping the microwire and microcatheter and steam shaping microcatheters. In addition, inflating a balloon just distal to the branch origin can act as a bouncing pad to force the microcatheter to make the difficult turn.…”

“…These techniques have been safely applied to ruptured and unruptured intracranial aneurysms, arteriovenous malformations (AVM), dural arteriovenous fistulas (dAVF), intra-arterial administration of chemotherapy, or acute stroke thrombectomies. 2-9…”

“…These techniques have been safely applied to ruptured and unruptured intracranial aneurysms, arteriovenous malformations (AVM), dural arteriovenous fistulas (dAVF), intra-arterial administration of chemotherapy, or acute stroke thrombectomies. [2][3][4][5][6][7][8][9] The crossed artery may be a posterior communicating artery (Pcomm), a vertebral artery (VA), or an anterior communicating artery (Acomm) depending on whether right and left (contralateral circulation) or anterior and posterior (opposite circulation) crossing is needed. Finally, these can also occur in a doublecrossing direction in which both anterior-posterior and right-left circulations are simultaneously crossed.…”

A review of technological innovations leading to modern endovascular brain aneurysm treatment

“…Technically, deployment of a flow diverter occurs in a distal to proximal fashion with the delivery catheter in the vessel distal to the aneurysm ( 97 ). The device is then unsheathed across the aneurysmal neck.…”