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Retrograde stenting through the posterior cerebral artery in coil embolization of the posterior communicating artery aneurysm

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

Protection techniques using stents or balloons are occasionally limited in coil embolization of wide-necked posterior communicating artery (PcomA) aneurysms in which the PcomA originated from the aneurysm neck at an acute angle. Here, we present two cases undergoing retrograde stenting through the posterior cerebral artery in coil embolization of the PcomA aneurysms.

Methods

To perform retrograde stenting, a microcatheter used for stent delivery was advanced from the vertebral artery (VA) to the terminal internal carotid artery (ICA) via the ipsilateral P1 and the PcomA. The aneurysm sac was selected with another microcatheter for coil delivery through the ipsilateral ICA. Coil embolization was performed under the protection of a stent placed from the terminal ICA to the PcomA.

Results

Deployment of the stent was successful in both aneurysms treated using retrograde stenting by the VA approach. Coil deployment was performed through the jailed microcatheter at first. The microcatheter was repositioned through the stent struts later in one case and another microcatheter was inserted into the sac through the stent struts in the other case. Both aneurysms were occluded properly with the coils without procedure-related complications.

Conclusion

By providing complete neck coverage, retrograde stenting for coil embolization in wide-necked PcomA aneurysms seems to be a good alternative treatment strategy, when the aneurysms are incorporating extended parts of the PcomA, and the PcomA and P1 are big enough to allow passage of the microcatheter for delivery of the stent. However, this technique should be reserved for those cases with the specific vascular anatomy.

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References

  1. Golshani K, Ferrell A, Zomorodi A et al (2010) A review of the management of posterior communicating artery aneurysms in the modern era. Surg Neurol Int 1:88

    Article  PubMed  Google Scholar 

  2. Peluso JP, van Rooij WJ, Sluzewski M et al (2008) A new self-expandable nitinol stent for the treatment of wide-neck aneurysms: initial clinical experience. AJNR Am J Neuroradiol 29:1405–1408

    Article  CAS  PubMed  Google Scholar 

  3. Weber W, Bendszus M, Kis B et al (2007) A new self-expanding nitinol stent (Enterprise) for the treatment of wide-necked intracranial aneurysms: initial clinical and angiographic results in 31 aneurysms. Neuroradiology 49:555–561

    Article  PubMed  Google Scholar 

  4. Biondi A, Janardhan V, Katz JM et al (2007) Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery 61:460–468

    Article  PubMed  Google Scholar 

  5. Piotin M, Blanc R, Spelle L et al (2010) Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke 41:110–115

    Article  PubMed  Google Scholar 

  6. Higashida RT, Halbach VV, Dowd CF et al (2005) Initial clinical experience with a new self-expanding nitinol stent for the treatment of intracranial cerebral aneurysms: the Cordis Enterprise stent. AJNR Am J Neuroradiol 26:1751–1756

    PubMed  Google Scholar 

  7. Benitez RP, Silva MT, Klem J et al (2004) Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery 54:1359–1367

    Article  PubMed  Google Scholar 

  8. Lozen A, Manjila S, Rhiew R et al (2009) Y-stent-assisted coil embolization for the management of unruptured cerebral aneurysms: report of six cases. Acta Neurochir 151:1663–1672

    Article  PubMed  Google Scholar 

  9. Moret J, Ross IB, Weill A et al (2000) The retrograde approach: a consideration for the endovascular treatment of aneurysms. AJNR Am J Neuroradiol 21:262–268

    CAS  PubMed  Google Scholar 

  10. Wanke I, Gizewski E, Forsting M (2006) Horizontal stent placement plus coiling in a broad-based basilar-tip aneurysm: an alternative to the Y-stent technique. Neuroradiology 48:817–820

    Article  PubMed  Google Scholar 

  11. Fitzpatrick D, Chen M, Meyers PM (2006) Horizontal Neuroform stent deployment for a ruptured basilar terminus aneurysm via the posterior communicating artery. J Vasc Interv Radiol 17:1687–1691

    Article  PubMed  Google Scholar 

  12. Siddiqui MA, Bhattacharya J, Lindsay KW et al (2009) Horizontal stent-assisted coil embolisation of wide-necked intracranial aneurysms with the Enterprise stent—a case series with early angiographic follow-up. Neuroradiology 51:411–418

    Article  PubMed  Google Scholar 

  13. Blackburn SL, Kadkhodayan Y, Shekhtman E, et al. (2012) Treatment of basilar tip aneurysms with horizontal PCA to PCA stent-assisted coiling: case series. J Neurointerv Surg [Epub ahead of print]

  14. Pride GL Jr, Welch B, Novakovic R et al (2009) Retrograde crossing stent placement strategies at the basilar apex for the treatment of wide necked aneurysms: reconstructive and deconstructive opportunities. J Neurointerv Surg 1:132–135

    Article  PubMed  Google Scholar 

  15. Puri AS, Erdem E (2009) Unusual intracranial stent navigation through the circle of Willis in a patient with recurrent basilar tip aneurysm during stent-assisted coiling. A case report. Interv Neuroradiol 15:81–86

    CAS  PubMed  Google Scholar 

  16. Kelly ME, Turner R, Gonugunta V et al (2007) Stent reconstruction of wide-necked aneurysms across the circle of Willis. Neurosurgery 61(5 Suppl 2):249–254

    Article  PubMed  Google Scholar 

  17. Raslan AM, Oztaskin M, Thompson EM et al (2011) Neuroform stent-assisted embolization of incidental anterior communicating artery aneurysms: long-term clinical and angiographic follow-up. Neurosurgery 69:27–37

    Article  PubMed  Google Scholar 

  18. Endo H, Sato K, Kondo R et al (2012) Tuberothalamic artery infarctions following coil embolization of ruptured posterior communicating artery aneurysms with posterior communicating artery sacrifice. AJNR Am J Neuroradiol 33:500–506

    Article  CAS  PubMed  Google Scholar 

  19. Ecker RD, Hanel RA, Levy EI et al (2007) Contralateral vertebral approach for stenting and coil embolization of a large, thrombosed vertebral-posterior inferior cerebellar artery aneurysm. Case report. J Neurosurg 107:1214–1216

    Article  PubMed  Google Scholar 

  20. Roh HG, Chun YI, Choi JW et al (2012) Retrograde stent placement for coil embolization of a wide-necked posterior inferior cerebellar artery aneurysm. Korean J Radiol 13:510–514

    Article  PubMed  Google Scholar 

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Acknowledgment

We thank Yoon-Kyung Choi for preparing the illustrations.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, Seoul, Korea

    Young Dae Cho, Kang Min Kim, Woong Jae Lee & Moon Hee Han

  2. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul, 110-744, Korea

    Hyun-Seung Kang, Jeong Eun Kim & Moon Hee Han

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  1. Young Dae Cho
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  2. Kang Min Kim
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  3. Woong Jae Lee
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  4. Hyun-Seung Kang
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Correspondence to Hyun-Seung Kang.

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Cho, Y.D., Kim, K.M., Lee, W.J. et al. Retrograde stenting through the posterior cerebral artery in coil embolization of the posterior communicating artery aneurysm. Neuroradiology 55, 733–739 (2013). https://doi.org/10.1007/s00234-013-1163-8

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  • DOI: https://doi.org/10.1007/s00234-013-1163-8

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