Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Microguidewire Looping to Traverse Stented Parent Arteries of Intracranial Aneurysms

  • Cho, Young Dae (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Rhim, Jong Kook (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Yoo, Dong Hyun (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kang, Hyun-Seung (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Jeong Eun (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Han, Moon Hee (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2016.07.19
  • Accepted : 2016.12.23
  • Published : 2017.03.01
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Abstract

Objective : Stents 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. Methods : To 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. Results : This 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. Conclusion : Microguidewire 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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References

  1. Benndorf G, Bender A, Lehmann R, Lanksch W : Transvenous occlusion of dural cavernous sinus fistulas through the thrombosed inferior petrosal sinus : report of four cases and review of the literature. Surg Neurol 54 : 42-54, 2000 https://doi.org/10.1016/S0090-3019(00)00260-3
  2. Chalouhi N, Jabbour P, Singhal S, Drueding R, Starke RM, Dalyai RT, et al. : Stent-assisted coiling of intracranial aneurysms : predictors of complications, recanalization, and outcome in 508 cases. Stroke 44 : 1348-1353, 2013 https://doi.org/10.1161/STROKEAHA.111.000641
  3. Cho YD, Kang HS, Kim JE, Son YJ, Lee JY, Lee SJ, et al. : Microcatheter looping technique for coil embolization of complex configuration middle cerebral artery aneurysms. Neurosurgery 71 : 1185-1191; discussion 1191, 2012 https://doi.org/10.1227/NEU.0b013e318271ee1a
  4. Cho YD, Lee JY, Seo JH, Lee SJ, Kang HS, Kim JE, et al. : Does stent implantation improve the result of repeat embolization in recanalized aneurysms? Neurosurgery 71(2 Suppl Operative) : ons253-ons259; discussion ons259, 2012
  5. Cho YD, Park SW, Lee JY, Lee JY, Seo JH, Kang HS, et al. : Nonoverlapping Y-configuration stenting technique with dual closed-cell stents in wide-neck basilar tip. Neurosurgery 70(2 Suppl Operative) : 244-249, 2012
  6. Cho WS, Kang HS, Kim JE, Kwon OK, Oh CW, Cho YD, et al. : Angle change of the parent arteries after stent-assisted coil embolization of wide-necked intracranial bifurcation aneurysms. Clin Radiol 69 : e63-e70, 2014 https://doi.org/10.1016/j.crad.2013.08.021
  7. Gory B, Klisch J, Bonafe A, Mounayer C, Beaujeux R, Moret J, et al. : Solitaire AB stent-assisted coiling of wide-necked intracranial aneurysms : short-term results from a prospective, consecutive, European multicentric study. Neuroradiology 55 : 1373-1378, 2013 https://doi.org/10.1007/s00234-013-1277-z
  8. Heller RS, Malek AM : Parent vessel size and curvature strongly influence risk of incomplete stent apposition in enterprise intracranial aneurysm stent coiling. AJNR Am J Neuroradiol 32 : 1714-1720, 2011 https://doi.org/10.3174/ajnr.A2584
  9. Heller RS, Safain M, Malek AM : Double-barrel entanglement of intracranial Enterprise stents resulting from undetected incomplete stent apposition. J Neurointerv Surg 4 : e38, 2012 https://doi.org/10.1136/neurintsurg-2011-010192
  10. Juszkat R, Nowak S, Smol S, Kociemba W, Blok T, Zarzecka A : Leo stent for endovascular treatment of broad-necked and fusiform intracranial aneurysms. Interv Neuroradiol 13 : 255-269, 2007 https://doi.org/10.1177/159101990701300305
  11. Kang HS, Kwon BJ, Kim JE, Han MH : Preinterventional clopidogrel response variability for coil embolization of intracranial aneurysms : clinical implications. AJNR Am J Neuroradiol 31 : 1206-1210, 2010 https://doi.org/10.3174/ajnr.A2051
  12. Kulcsar Z, Goricke SL, Gizewski ER, Schlamann M, Sure U, Sandalcioglu IE, et al. : Neuroform stent-assisted treatment of intracranial aneurysms : long-term follow-up study of aneurysm recurrence and in-stent stenosis rates. Neuroradiology 55 : 459-465, 2013 https://doi.org/10.1007/s00234-013-1143-z
  13. Lawson MF, Newman WC, Chi YY, Mocco JD, Hoh BL : Stent-associated flow remodeling causes further occlusion of incompletely coiled aneurysms. Neurosurgery 69 : 598-603, 2011 https://doi.org/10.1227/NEU.0b013e3182181c2b
  14. Lee SJ, Cho YD, Kang HS, Kim JE, Han MH : Coil embolization using the self-expandable closed-cell stent for intracranial saccular aneurysm : a single-center experience of 289 consecutive aneurysms. Clin Radiol 68 : 256-263, 2013 https://doi.org/10.1016/j.crad.2012.07.017
  15. Liu H, Choe J, Jung SC, Song Y, Yang KH, Park KJ, et al. : Does a lowwall coverage stent have a flow diverting effect in small aneurysms? Neurointervention 10 : 89-93, 2015 https://doi.org/10.5469/neuroint.2015.10.2.89
  16. Lubicz B : Linear stent-assisted coiling : another way to treat very widenecked intracranial aneurysms. Neuroradiology 53 : 457-459, 2011 https://doi.org/10.1007/s00234-010-0792-4
  17. Park KY, Kim BM, Kim DJ : Comparison between balloon-assisted and stent-assisted technique for treatment of unruptured internal carotid artery aneurysms. Neurointervention 11 : 99-104, 2016 https://doi.org/10.5469/neuroint.2016.11.2.99
  18. Park W, Song Y, Park KJ, Koo HW, Yang K, Suh DC : Hemodynamic characteristics regarding recanalization of completely coiled aneurysms : Computational fluid dynamic analysis using virtual models comparison. Neurointervention 11 : 30-36, 2016 https://doi.org/10.5469/neuroint.2016.11.1.30
  19. Piotin M, Blanc R, Spelle L, Mounayer C, Piantino R, Schmidt PJ, et al. : Stent-assisted coiling of intracranial aneurysms : clinical and angiographic results in 216 consecutive aneurysms. Stroke 41 : 110-115, 2010 https://doi.org/10.1161/STROKEAHA.109.558114
  20. Roy D, Milot G, Raymond J : Endovascular treatment of unruptured aneurysms. Stroke 32 : 1998-2004, 2001 https://doi.org/10.1161/hs0901.095600
  21. Yashar P, Kan PT, Levy EI : Horizontal deployment of an intracranial stent via an antegrade approach for coil embolization of a basilar apex aneurysm : technical note. J Neurointerv Surg 3 : 355-357, 2011 https://doi.org/10.1136/jnis.2010.004481