Endovascular Treatment of Wide-necked Cerebral Aneurysms with an Acute Angle Branch Incorporated into the Sac: Novel methods of Branch Access in 8 Aneurysms

Autor: Dae-Hee Seo, Kyu Chang Lee, Young-Soo Ha, Bae Ju Kwon
Jazyk: angličtina
Rok vydání: 2012
Předmět:
Zdroj: Neurointervention, Vol 7, Iss 2, Pp 93-101 (2012)
Neurointervention
ISSN: 2233-6273
2093-9043
Popis: Since the International Subarachnoid Aneurysm Trial, endovascular treatment gained ground in the management of cerebral aneurysms [1]. Currently, coiling largely supersedes clipping in the treatment of cerebral aneurysms and, with the rapid development of devices and techniques, the field of neurovascular intervention is likely to expand further. However, the lower durability of coiling has yet to be solved. Complex and difficult aneurysms for coiling refer to aneurysms that have a wide neck, very small diameter, bizarre shape (e.g., multilobulation, tube-like elongation, or bent shape), anatomical complexity precipitating the microcatheter kickback, branch incorporation into the sac, and so on. If an incorporated branch supplies the pivotal area of the brain, every effort should be made to preserve that branch during the procedures. However in most cases, difficulties are encountered in the superselection of the incorporated branch and is frequently weighted as a result of acute angle branching. Moreover, aggressive intra-aneurysmal wire navigation may lead to catastrophic aneurysm perforation. If no pre-specified method for preserving the branch is planned beforehand, the procedure may be aborted or finished with complications. If a nonbranch-selective technique (NT), such as multi-catheter or balloon remodeling technique, or stent-assisted technique that places a stent in the parent artery, may result in significant branch compromise and thrombosis, it would be very hard to recanalize the occluded branch because of excessive difficulty in branch access. Particularly in balloon remodeling technique [2], as a balloon catheter system is placed in the parent artery across the aneurysm neck, overinflation and intraaneurysmal herniation of the compliant balloon are necessary for protection of the incorporated branch and its remodeling capability can be limited when the incorporated branch orifice is poorly covered. As for branch-selective technique (BT), including both stent-assisted coiling and catheter-assisted technique through the incorporated branch, an excessively shaped microguidewire usually does not meet the required angle for accessing the incorporated, acute angle branch and easily passes the branch orifice toward the aneurysm dome. However, aggressive wire navigation for branch access should be restricted to avoid the risk of aneurysm perforation. Therefore, for the purpose of preserving the incorporated branch, NT requires a sustainable smaller coil frame to leave enough room in the aneurysm neck toward incorporated branch, whereas BT necessitates special methods of wire and microcatheter manipulations to safely superselect the incorporated, acute angle branch. Recently, our institution has set up a biplane system with three-dimensional imaging capability for endovascular procedures, and in case of wide-necked and branch-incorporated aneurysm, we have made efforts at finding how to smoothly access the incorporated branch on a case-by-case basis. We sought to evaluate the technical success rate, complications, and new neurological deficits of the BT procedures.
Databáze: OpenAIRE
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