J Cerebrovasc Endovasc Neurosurg.  2014 Jun;16(2):125-130. 10.7461/jcen.2014.16.2.125.

Balloon Anchor Technique for Pipeline Embolization Device Deployment Across the Neck of a Giant Intracranial Aneurysm

• Ding D
• Starke RM
• Evans AJ
• Jensen ME
• Liu KC

• KMID: 1963181
• DOI: http://doi.org/10.7461/jcen.2014.16.2.125

Abstract

Treatment of giant intracranial aneurysms, via either surgical or endovascular approaches, is associated with a high level of technical difficulty as well as a high rate of treatment-related morbidity and mortality. Flow-diverting stents, such as the Pipeline embolization device (PED), have drastically altered the therapeutic strategies for the treatment of giant aneurysms. Gaining endovascular access using a microcatheter to the portion of the parent artery distal to the aneurysm neck is requisite for safe and effective stent deployment. Giant aneurysms are often associated with vascular tortuosity, which necessitates significant catheter support systems to enable maneuvering of PEDs across the aneurysm neck. This is also required in order to reduce the probability of stent herniation within giant aneurysms. We report on a case of a giant supraclinoid internal carotid artery (ICA) aneurysm which was treated successfully with a PED utilizing a balloon anchor technique to facilitate direct microcatheter access across the aneurysm neck.

Keyword

Endovascular procedures; Endovascular techniques; Intracranial aneurysm; Stent; Stroke; Subarachnoid hemorrhage

MeSH Terms

Aneurysm
Arteries
Carotid Artery, Internal
Catheters
Endovascular Procedures
Humans
Intracranial Aneurysm*
Mortality
Neck*
Parents
Stents
Stroke
Subarachnoid Hemorrhage

Figure

• 

  Fig. 1 Diagnostic cerebral angiography, (A) lateral and (B) AP projections and (C, D) 3D reconstruction, shows a giant, left superior hypophyseal aneurysm measuring 2.9 cm in maximal diameter. AP = anterior-posterior.

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  Fig. 2 A Scepter C balloon within a DAC 044 catheter was placed over a Transend 014 microguidewire and advanced into the giant, left supraclinoid ICA aneurysm. Due to the hemodynamics within the aneurysm sac, a significant length of redundant catheter was looped within the sac. (A) The Scepter C balloon was advanced distally into the left MCA and inflated. After balloon inflation, the DAC 044 catheter was pulled down so that the length of the intrasaccular redundant catheter was decreased (B) until the catheter traversed only the aneurysm neck without any portion remaining in the sac, as demonstrated on the (C) lateral and (D) AP fluoroscopic projections. ICA = internal carotid artery; MCA = middle cerebral artery

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  Fig. 3 (A) Final control angiography, AP projection, performed after deployment of a 5.0 × 30 mm PED through an Excelsior XT-27 microcatheter across the aneurysm neck. Subtracted view, (B) lateral and (C) AP projections, after angioplasty of the PED using a Trek 3 × 12 coronary balloon in order to dilate two stenotic segments in the mid-portion of the device, which were noted after deployment. PED = Pipeline embolization device

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