Stent-Assisted Coiling of a Sidewall Aneurysm of the Distal Middle Cerebral Artery: 2-Dimensional Operative Video. Issue 1 (15th December 2020)

• Record Type: Journal Article
• Authors: Cavalcanti, Daniel D; Delavari, Nader; Riina, Howard A
• Is Part Of: Operative neurosurgery. Volume 20:Issue 1(2021)
• Page Start: E37
• Page End: E38
• Publication Date: 2020-12-15
• Subjects: Intracranial aneurysm -- Endovascular neurosurgery -- Middle cerebral artery -- Coil -- Stent; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1093/ons/opaa332
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract: Sidewall aneurysm treatment often requires complex management strategies. These can include advanced clipping techniques or stent-assisted coiling techniques. Endovascular coiling alone has been associated with high recurrence rates and is often not feasible. 1-4 Flow-diversion embolization has recently become a standard of care for many aneurysms, demonstrating high occlusion rates. 4, 5 However, the third generation of coil-assist stents can be delivered with 0.0165" microcatheters, being an ideal adjunct to manage this group of aneurysms in more distal locations. In this video, a 16-yr-old teenager with Parry-Romberg syndrome and congenital adrenal hyperplasia had an incidental finding of a 6.5-mm sidewall aneurysm arising off the angular branch of the left middle cerebral artery, found during the work-up of complex partial seizures. The patient consented to the procedure. Due to his young age and aneurysm size, a decision was made to treat the aneurysm through an endovascular approach. Under general anesthesia, a transfemoral approach was carried out using a 6-French short sheath. A 6-French guiding catheter was left in the distal cervical left internal carotid artery; a 0.0165" microcatheter was used to first deploy a 3.0 × 15 mm Neuroform Atlas stent, completely covering the length of the aneurysm. Then, the stent was traversed with the microcatheter to coil the aneurysm. Follow-up cerebral angiogram confirmed complete occlusion of the aneurysm.