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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(04): 1122-1125
DOI: 10.4103/ajns.AJNS_163_19
Original Article

A novel technique for stent-assisted coil embolization of intracranial aneurysms: The wireless trans-cell approach

Tomotaka Ohshima
1   Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi
,
Reo Kawaguchi
2   Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi
,
Ryuya Maejima
2   Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi
,
Naoki Matsuo
2   Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi
,
Shigeru Miyachi
1   Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi
2   Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi
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Background: When inserting coils under stent deployment, a jailed microcatheter technique is typically applied as a first line approach. However, the trans cell approach might be required to achieve satisfactory complete occlusion. The trans cell approach occasionally ends in failure because the catheter cannot safely follow a proceeding guidewire into the aneurysm. Here, we report the new wireless trans cell approach (WTA), which allows feasible and safe catheter navigation through the stent strut into the aneurysm, without a proceeding guidewire. Methods: A straight tip microcatheter was used, and the tip was shaped as a very small bend of approximately 45°. The side aspect of the catheter tip exhibited a right angled edge, while the front aspect showed a round curve in the advancing direction. We compared the 45° microcatheter with a straight tip microcatheter using a silicon vascular model and then applied the WTA in a case of an unruptured basilar apex aneurysm. Results: Catheter navigation through the stent strut was smoother with the WTA than the conventional wire assisted approach. Our case of a basilar apex aneurysm was successfully treated with the dual catheter technique, which involved a jailed catheter and navigation using the WTA. After stent deployment from the right posterior cerebral artery to the basilar artery through the 45° microcatheter, the WTA was applied using the same catheter. No stress was detected during catheter navigation through the stent strut into the aneurysm. Conclusions: The WTA is associated with smoother catheter navigation compared with the conventional wire assisted approach in cases of a terminal type aneurysm.

Key-words:

Coil embolization - endovascular treatment - intracranial aneurysms - stent

Financial support and sponsorship

Nil.




Publikationsverlauf

Artikel online veröffentlicht:
09. September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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