Microcatheter neck bridging and incorporated branch vessel protection for coil embolization of a wide-neck ruptured aneurysm: technical case report

Neurosurgery. 2011 Mar;68(1 Suppl Operative):40-3; discussion 43-4. doi: 10.1227/NEU.0b013e318207819f.

Abstract

Background and importance: A novel technique in which microcatheter neck bridging of a ruptured wide-neck posterior communicating artery aneurysm was performed by intra-aneurysmal catheter navigation into a fetal configuration posterior cerebral artery (PCA) branch vessel arising from the sac.

Clinical presentation: An 88-year-old woman with a Hunt and Hess grade 1 and Fisher grade 4 subarachnoid hemorrhage was identified as having a wide-neck posterior communicating artery aneurysm and an isolated fetal configuration PCA with origins from the aneurysm sac. Delivery of a bare platinum Guglielmi detachable coil within the aneurysm lumen resulted in persistent coil prolapse into the parent vessel with occlusion of the incorporated vital PCA origin. A microcatheter was then navigated through the aneurysm lumen and into the fetal configuration PCA. This was retained within the PCA with resultant aneurysm neck narrowing and branch vessel protection. A second microcatheter was placed in the aneurysm lumen for coil delivery. Complete aneurysm occlusion with patency of the PCA without coil loop prolapse into the parent vessel was achieved.

Conclusion: The presence of normal branch vessels arising from the dome is a limitation for endovascular techniques. To the best of our knowledge, no prior description of a dual-microcatheter technique with selective catheter placement within an important intra-aneurysmal branch vessel has been published. The vital branch vessel was protected and the wide-neck aneurysm completely occluded. Novel placement of microcatheters further expands the range of complex configuration aneurysms amenable to endovascular coiling.

Publication types

  • Case Reports
  • Technical Report

MeSH terms

  • Aged, 80 and over
  • Aneurysm, Ruptured / complications
  • Aneurysm, Ruptured / surgery*
  • Angiography, Digital Subtraction / methods
  • Embolization, Therapeutic / instrumentation*
  • Embolization, Therapeutic / methods*
  • Endovascular Procedures / methods
  • Female
  • Humans
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / surgery*