The Neck-Crossing Technique Using the Low-Profile Distal Access Catheter in Flow Diverter Placement for Dissecting Posterior Cerebral Artery Aneurysm: A Case Report.

Asian journal of neurosurgery Pub Date : 2024-10-24 eCollection Date: 2025-03-01 DOI:10.1055/s-0044-1791711
Akiko Hasebe, Ichiro Nakahara, Kenichiro Suyama, Shoji Matsumoto, Jun Morioka, Tetsuya Hashimoto, Jun Tanabe, Sadayoshi Watanabe, Takeya Suzuki, Junpei Koge
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Abstract

We report a case in which a novel distal access catheter proved successful in the placement of a flow diverter for a challenging distal cerebral artery lesion. We discuss the advantages and pitfalls of this technique and considerations for its use. A 74-year-old female presented with intermittent headaches, and was diagnosed with a dissecting aneurysm at the proximal right posterior cerebral artery with a sharp bleb, measuring 9.8 mm in diameter. Given the complex vascular anatomy, stent-assisted coil embolization was initially considered but deemed high risk for dual catheter for jailing technique with 6-Fr size guiding catheter due to the tortuosity and stenosis of the parent vessel. Therefore, we opted for flow diverter treatment, which presented its challenges during delivery. By employing a low-profile distal access catheter, Phenom Plus (outer diameter: 4.2-Fr. inner diameter: 1.13 mm; Medtronic, Minneapolis, Minnesota, United States), with a minimal ledge between it and the delivery catheter, Phenom 27 (outer diameter: 2.8-Fr, 0.91 mm; Medtronic), we successfully crossed the neck of the aneurysm with Phenom Plus and placed the flow diverter. While acknowledging potential risks, this case demonstrates the value of the neck-crossing technique using a low-profile distal access catheter as an alternative option for treating challenging peripheral artery aneurysms with flow diverters. This technique offers promise in specific situations where conventional methods pose challenges.

低侧远端导尿管在脑后动脉瘤分流术中应用过颈技术一例报告。
我们报告了一个病例,其中一个新的远端通路导管证明成功地安置了一个具有挑战性的远端大脑动脉病变的分流器。我们将讨论这种技术的优点和缺陷,以及使用时的注意事项。患者74岁,女性,以间歇性头痛为主诉,经诊断为右侧大脑后动脉近端夹层动脉瘤,伴直径9.8 mm的尖锐气泡。考虑到复杂的血管解剖结构,最初考虑支架辅助线圈栓塞,但由于母血管的扭曲和狭窄,6-Fr大小的引导导管双管监禁技术被认为风险高。因此,我们选择了分流处理,这在交付过程中提出了挑战。Phenom Plus(外径:4.2 fr)采用低侧远端导尿管。内径:1.13 mm;美敦力公司,明尼阿波利斯,明尼苏达州,美国),其与输送导管之间的间隙最小,Phenom 27(外径:2.8 fr, 0.91 mm;在美敦力公司(Medtronic)的手术中,我们使用Phenom Plus成功穿过动脉瘤颈部并放置了分流器。在承认潜在风险的同时,本病例证明了颈部交叉技术的价值,使用低姿态远端通路导管作为使用血流分流器治疗挑战性外周动脉瘤的替代选择。在传统方法面临挑战的特定情况下,该技术提供了希望。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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