J Korean Neurosurg Soc.  2013 Apr;53(4):241-244. 10.3340/jkns.2013.53.4.241.

Temporary Semi-Jailing Technique for Coil Embolization of Wide-Neck Aneurysm with Small Caliber Parent Artery Following Incomplete Clipping

• Byun JS
• Kim JK
• Lee HY
• Hwang SN

• KMID: 1426211
• DOI: http://doi.org/10.3340/jkns.2013.53.4.241

Abstract

The authors describe the use of a self-expandable stent in a temporary deployment for treatment of a very wide-neck A1 segment of anterior cerebral artery (ACA) aneurysm following incomplete clipping. A 39-year-old hypertensive man presenting with seizure-like movement underwent computed tomography, which showed acute subarachnoid hemorrhage and an A1 segment of ACA aneurysm with superior and inferior projection. He underwent surgical clipping of the aneurysm, but superior and posterior portion of wide-neck aneurysm remained. We decided to treat the remnant aneurysm using an endovascular modality. After selection of the aneurysm, coil packing was performed assisted by the temporary semi-jailing technique. The Enterprise stent (Cordis Neurovascular, Miami, FL, USA) was deployed and recaptured repeatedly for angiography to ensure safety of the small caliber parent artery. Successful semi-deployment and recapture of the stent allowed subtotal coil occlusion of the aneurysm with good anatomic and clinical results. No complications were encountered. The stent could be recaptured up to the point where the proximal end of the stent marker was aligned with distal marker band of the microcatheter, approximately 70% of the stent length. The temporary semi-jailing technique is feasible for wide-neck aneurysm with small caliber parent artery.

Keyword

Intracranial aneurysm; Endovascular therapy; Stent; Surgical clipping

MeSH Terms

Aneurysm
Angiography
Anterior Cerebral Artery
Arteries
Dietary Sucrose
Humans
Intracranial Aneurysm
Parents
Stents
Subarachnoid Hemorrhage
Surgical Instruments
Dietary Sucrose

Figure

• 

  Fig. 1 A and B : Preoperative CT demonstrating subarachnoid hemorrhage and aneurysm in right A1 segment of anterior cerebral artery. C and D : Postoperative angiogram showing a remnant aneurysm in right A1 segment of anterior cerebral artery.

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  Fig. 2 Sequence of steps during temporary stent-assisted coiling. Note the stent distal markers (white arrow) and microcatheter tip position (black arrow) during coiling. Whenever each coil inserted, the stent was partially recaptured into the Prowler Select Plus microcatheter then the SL-10 microcatheter was removed for angiography to ensure safety of the small caliber parent artery (D).

• 

  Fig. 3 Illustration of the temporary semi-jailing technique. A : Selection of the aneurysm with microcatheter with a partially introduced coil and introduction of the Enterprise stent. B : Coil embolization with partial deployment of the stent. C : Recapture of the stent after partial coiling. D : Stable coil mass after removal of the microcatheter.

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  Fig. 4 Final angiography (A) and 3 dimensional reconstruction image (B) demonstrated the coiled aneurysm without parent vessel stenosis or distal flow compromise.

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