Pericallosal aneurysm coiling with a "hubbed" 167 cm 0.013″ headway duo via a transradial approach. (July 2018)

• Record Type: Journal Article
• Authors: Gross, Bradley A.; Kenmuir, Cynthia L.; Ares, William J.; Jadhav, Ashutosh P.; Jovin, Tudor G.; Jankowitz, Brian T.
• Is Part Of: Journal of clinical neuroscience. Volume 53(2018)
• Page Start: 273
• Page End: 275
• Publication Date: 2018-07
• Subjects: Aneurysm -- Coiling -- Microcatheter -- Transradial; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.04.049
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Straightening access anatomy with an Amplatz may allow for more distal advancement of base catheters to access distal cerebrovascular pathology in cases of extreme tortuosity. The combination of a 6 French guide catheter and 5 French Sofia provides an excellent triaxial support platform for transradial approaches. Distal aneurysms that may not be reached with typical 150 cm coil catheters may be accessed with 167 cm 0.013 in. microcatheters and still coiled. Abstract: Cerebral aneurysms in patients with extreme proximal tortuosity may contraindicate endovascular therapy as a result of both the approach and an inability to navigate a coil-compatible microcatheter into the aneurysm due to microcatheter length. We present a 72 year-old male with multiple medical comorbidities admitted with a grade 3, ruptured pericallosal aneurysm. Aortoiliac disease contraindicated a transfemoral approach and thus a 6 French 105 cm guide catheter was advanced through a 6 French short radial sheath into a bovine left common carotid artery. After straightening proximal access anatomy with an Amplatz wire to allow advancement of the guide catheter into the internal carotid artery, a 167 cm 0.013 in. headway duo was advanced through a 5 French Sofia through the guide catheter and "hubbed" to enter the aneurysm. The aneurysm was then successfully coil embolized with 4 Target Ultrasoft coils. This case illustrates the utility of a 167 cm microcatheter for coil embolization of a pericallosal aneurysm with significant proximal tortuosity via a transradial approach. Despite its 0.013 in. inner diameter and length, common Target coils were compatible and deployed without incident.