Short-segment Internal Trapping for Symptomatic Thrombosed Large Fusiform Vertebral Artery Aneurysms (Bird’s Nest Trapping): A Technical Note
| Autor: | Tetsuya Tsukada, Kinya Yokoyama, Kenji Uda, Takashi Izumi, Asuka Elisabeth Kropp, Masahiro Nishihori, Yoshio Araki, Toshihiko Wakabayashi |
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| Rok vydání: | 2021 |
| Předmět: |
endovascular treatment
Male medicine.medical_specialty Medullary cavity Vertebral artery Infarction Balloon 030218 nuclear medicine & medical imaging Birds 03 medical and health sciences 0302 clinical medicine Aneurysm medicine.artery Technical Note medicine Animals Humans Vertebral Artery business.industry thrombosed aneurysm Intracranial Aneurysm Thrombosis Technical note Enbucrilate medicine.disease NBCA Embolization Therapeutic internal trapping medicine.anatomical_structure Rotational angiography Surgery vertebral artery aneurysm Neurology (clinical) Radiology business 030217 neurology & neurosurgery Artery |
| Zdroj: | Neurologia medico-chirurgica |
| ISSN: | 1349-8029 0470-8105 |
| DOI: | 10.2176/nmc.tn.2020-0329 |
| Popis: | Internal trapping with coils is an established treatment of symptomatic large non-branching thrombosed fusiform vertebral artery aneurysms (VAA). However, when perforators arise near the aneurysm neck, parent artery occlusion has a high risk of causing medullary infarction. As an alternative treatment, we performed short-segment internal trapping of the artery using n-butyl-2-cyanoacrylate (NBCA) and coils (bird's nest trapping). Before treatment, perianeurysmal perforators are carefully detected using high-resolution three-dimensional rotational angiography (3DRA). Double microcatheters are advanced to the distal portion of the aneurysm through a balloon guiding catheter where coils are deployed without tight packing. Then, NBCA is injected into the coil mass, taking care to preserve perforators and significant branches. The same maneuver is repeated in the proximal portion of the aneurysm. Coil placement is avoided within the middle of the aneurysm; however, if necessary, only a small number of coils are placed to prevent worsening of mass effect. Two quinquagenarian males presented with a large thrombosed fusiform VAA that caused symptoms due to mass effect. In each case, perforators arose from the parent artery and short-segment internal trapping with NBCA and coils was performed. Symptoms improved after treatment and follow-up imaging confirmed aneurysm shrinkage with no long-time recurrence. In symptomatic large fusiform VAAs where the distance from the lesion to important perforators is extremely short, internal trapping using a combination of NBCA and coils can be more useful than conventional internal trapping. |
| Databáze: | OpenAIRE |
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