Dual Microwire Rail Technique to Advance a Microcatheter Past the Ostium of a Dissecting Carotid Artery Aneurysm for Flow Diverter Deployment: 2-Dimensional Operative Video. Issue 6 (23rd August 2019)

• Record Type: Journal Article
• Authors: Vakharia, Kunal; Munich, Stephan A; Waqas, Muhammad; McPheeters, Matthew J; Levy, Elad I
• Is Part Of: Operative neurosurgery. Volume 18:Issue 6(2020)
• Page Start: E230
• Page End: E231
• Publication Date: 2019-08-23
• Subjects: Dissecting aneurysm -- Dual microwire rail -- Pipeline embolization device; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1093/ons/opz251
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract: Flow diversion using a Pipeline embolization device (PED; Medtronic, Dublin, Ireland) is an effective therapy for treating cavernous aneurysms. Currently, flow diverters require a 0.027-inch microcatheter for deployment. To navigate across these aneurysms, a 0.014-inch microwire is used, which often does not offer a sturdy enough rail to advance a 0.027-inch microcatheter past dissecting artery aneurysm ostia. We present a patient with a right cavernous dissecting carotid artery aneurysm. A step off between the 0.027-inch VIA microcatheter (MicroVention Terumo, Tustin, California) and 0.014-inch Synchro 2 microwire (Stryker Neurovascular, Fremont, California) resulted in difficulty with navigation of the microcatheter across the dissected portion of the aneurysm. A dual microwire rail technique involving two 0.014-inch Synchro 2 microwires was used to advance the VIA microcatheter past the dissecting artery aneurysm ostia for PED deployment. The introduction of the second microwire eliminated the step off between the microwire and microcatheter, providing a stronger rail and easier navigation of the microcatheter, without aggressive pushing. Postembolization runs showed optimal wall apposition and contrast stasis within the aneurysm, with successful flow diversion of the aneurysm. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary.