• World Neurosurg · May 2023

    Case Reports

    Real-time monitoring of aneurysm catheterization during stent-assisted coiling for irregularly shaped intracranial aneurysms: The scope technique.

    • Daisuke Yamazaki, Yoshiki Hanaoka, Jun-Ichi Koyama, Takuya Nakamura, Satoshi Kitamura, and Tetsuyoshi Horiuchi.
    • Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
    • World Neurosurg. 2023 May 1; 173: 889388-93.

    ObjectiveStent-assisted coiling (SAC) using the jailing technique is a well-established treatment for wide-neck intracranial aneurysms. However, low-volume packing, which is a key factor for aneurysm recanalization, can occur in patients with irregularly shaped aneurysms. We have devised a real-time monitoring system for aneurysm catheterization that allows the intentional placement of the jailed coil-delivery microcatheter and deployed stent, referred to as the "scope" technique. Herein, we present a case of irregularly shaped anterior communicating artery (ACoA) aneurysm successfully treated with SAC using this technique.MethodsA 72-year-old woman diagnosed with an unruptured wide-neck ACoA aneurysm that was eccentric to the parent ACoA and overhanging posteriorly underwent SAC using this technique. Bilateral transradial quadraxial systems (6-Fr Simmons guiding sheath/6-Fr intermediate catheter/3.2-Fr intermediate catheter/microcatheter) were established via right and left internal carotid artery. The stent-delivery microcatheter was advanced into the left A2 via the right A1, leaving a 0.014″ microguidewire for visualization under fluoroscopic guidance. To place the coil-delivery microcatheter in the middle of the aneurysm after stent deployment, the coil-delivery microcatheter was cannulated into the aneurysm via the left A1, intendedly through the posterior side of the stent-delivery microcatheter in the down-the-barrel view of the parent ACoA (the scope technique).ResultsAfter stent deployment, SAC of the aneurysm was successfully achieved.ConclusionsUsing this technique, the coil-delivery microcatheter was cannulated into the aneurysm, while monitoring its positional relationship with the stent-delivery microcatheter in real time. This technique is a useful treatment option for irregularly shaped and wide-neck aneurysms.Copyright © 2023 Elsevier Inc. All rights reserved.

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