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Research ArticleINTERVENTIONAL

Combination of Multicatheter Plus Stent or Balloon for Treatment of Complex Aneurysms

H.J. Jeon, B.M. Kim, D.J. Kim, K.Y. Park, J.W. Kim and D.I. Kim
American Journal of Neuroradiology February 2016, 37 (2) 311-316; DOI: https://doi.org/10.3174/ajnr.A4526
H.J. Jeon
aFrom the Department of Neurosurgery (H.J.J.), Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
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B.M. Kim
bDepartments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.)
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D.J. Kim
bDepartments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.)
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K.Y. Park
cNeurosurgery (K.Y.P.), Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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J.W. Kim
bDepartments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.)
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D.I. Kim
bDepartments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.)
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Article Figures & Data

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  • Fig 1.
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    Fig 1.

    A 58-year-old man presenting with Hunt and Hess grade 3 subarachnoid hemorrhage. A, Unenhanced CT shows diffuse subarachnoid hemorrhage in the basal cistern. The arrow indicates the ruptured aneurysm. B, The 3D reconstruction image shows a 17-mm posterior communicating artery (black arrow) aneurysm with incorporation of the anterior choroidal artery (white arrow). C, A spot image shows HyperForm balloon (arrow) navigation after positioning 2 microcatheters (arrowheads) in the aneurysm sac. D, An illustration explains the technique for treating this aneurysm. During the protection of the anterior choroidal artery by an overinflated balloon, a stable coil frame basket is made by interleaving 2 coils. E, Angiogram after balloon deflation confirms a stable coil basket without compromising the origin of the incorporated anterior choroidal artery (white arrow). Arrowheads indicate 2 microcatheters for coil delivery, and black arrows indicate proximal and distal balloon markers. F, Completion control angiogram shows complete occlusion of the aneurysm sac with preservation of the incorporated anterior choroidal artery. The 40-month follow-up MR angiogram source (G) and MIP reconstruction (H) images show no recurrence (asterisk) and a patent anterior choroidal artery (white arrow).

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    Fig 2.

    A 27-year-old woman with underlying Moyamoya disease and an unruptured basilar tip aneurysm. A, The 3D reconstruction image shows an unruptured basilar tip aneurysm with a deep lobulation. B, A spot image shows coil placement after positioning 2 microcatheter tips (arrowheads) in the large and small lobes of the sac, respectively, and horizontal stent placement (arrows) via the posterior communicating artery. C, Completion control angiogram shows uniform coil packing of the lobulated sac, resulting in complete occlusion of the aneurysm.

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    Fig 3.

    A 59-year-old woman presenting with an unruptured right ophthalmic artery aneurysm. A, The 3D reconstruction shows a wide-neck and shallow aneurysm with incorporation of the ophthalmic artery. Arrows indicate the ophthalmic artery. Unsubtracted angiogram (B) and flat panel CT (C) after Neuroform stent placement show 2 microcatheter tips in the aneurysm sac, one of which faces the ophthalmic artery origin. Black arrows indicate the struts of the Neuroform stent, and white arrows indicate the ophthalmic artery. Note that the 1 catheter tip (white arrowhead) faces the ophthalmic artery origin and the other catheter tip (black arrowhead) faces the aneurysm dome. D, While a helical 1.5 mm × 2 cm coil (arrowheads) occupies the region (arrow) where the ophthalmic artery branches off and the stent protects the aneurysm neck, an initial coil basket is successfully formed by using the other catheter. E, After retrieval of the protection coil, the initial coil basket is stable and the region from which the ophthalmic artery branches off is well-preserved. F, Completion angiogram indicates that the aneurysm was nearly completely embolized with intentional preservation of the region from which the ophthalmic artery (arrows) branches off. G, The 6-month follow-up MR angiogram source image shows no recurrence. The arrow indicates the ophthalmic artery origin, and arrowheads indicate the coiled aneurysm.

Tables

  • Figures
  • Summary of complex aneurysms and the results of the combination technique using multicatheter plus stent or balloon

    No. of patients62
        Age (yr) (mean)54.0 ± 12.0
        Male/female12 (19.4%):50 (80.6%)
    Presentation (No.)62
        Ruptured12 (19.4%)
        Unruptured50 (80.6%)
    Type of complex aneurysms
        Wide neck plus branch incorporated41 (66.1%)
        Wide neck plus deep lobulation16 (25.8%)
        Wide neck plus both5 (8.1%)
    Sac diameter (mm) (mean) (range)8.7 ± 3.4 (3.5–19.0)
    Neck diameter (mm) (mean) (range)6.0 ± 2.3 (3.2–14.0)
    Location of complex aneurysm
        Internal carotid artery29 (46.8%)
        Middle cerebral artery5 (8.1%)
        Anterior cerebral artery8 (12.9%)
        Basilar artery20 (32.2%)
    Type of combination technique
        Multicatheter plus stent (No.)42 (67.7%)
        Multicatheter plus balloon (No.)20 (32.3%)
    Treatment-related morbidity1 (1.6%)
    Treatment-related mortality0
    Immediate angiographic outcome
        Complete27 (43.6%)
        Neck remnant34 (54.8%)
        Incomplete1 (1.6%)
    Follow-up angiograms (No.)50 (80.6%)
        Duration (mo) (mean) (range)21 (6–65)
        Follow-up results
            Improved or stable43 (86.0%)
            Minor recurrence4 (8.0%)
            Major recurrence3 (6.0%)
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American Journal of Neuroradiology: 37 (2)
American Journal of Neuroradiology
Vol. 37, Issue 2
1 Feb 2016
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Combination of Multicatheter Plus Stent or Balloon for Treatment of Complex Aneurysms
H.J. Jeon, B.M. Kim, D.J. Kim, K.Y. Park, J.W. Kim, D.I. Kim
American Journal of Neuroradiology Feb 2016, 37 (2) 311-316; DOI: 10.3174/ajnr.A4526

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Combination of Multicatheter Plus Stent or Balloon for Treatment of Complex Aneurysms
H.J. Jeon, B.M. Kim, D.J. Kim, K.Y. Park, J.W. Kim, D.I. Kim
American Journal of Neuroradiology Feb 2016, 37 (2) 311-316; DOI: 10.3174/ajnr.A4526
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