Endovascular Treatment of Wide-necked Cerebral Aneurysms with an Acute Angle Branch Incorporated into the Sac: Novel methods of Branch Access in 8 Aneurysms

摘要: Since the International Subarachnoid Aneurysm Trial, endovascular treatment gained ground in management of cerebral aneurysms [1]. Currently, coiling largely supersedes clipping and, with rapid development devices and techniques, field neurovascular intervention is likely to expand further. However, lower durability has yet be solved. Complex difficult for refer that have a wide neck, very small diameter, bizarre shape (e.g., multilobulation, tube-like elongation, or bent shape), anatomical complexity precipitating microcatheter kickback, branch incorporation into sac, so on. If an incorporated supplies pivotal area brain, every effort should made preserve during procedures. However most cases, difficulties are encountered superselection frequently weighted as result acute angle branching. Moreover, aggressive intra-aneurysmal wire navigation may lead catastrophic aneurysm perforation. no pre-specified method preserving planned beforehand, procedure aborted finished complications. nonbranch-selective technique (NT), such multi-catheter balloon remodeling technique, stent-assisted places stent parent artery, significant compromise thrombosis, it would hard recanalize occluded because excessive difficulty access. Particularly [2], catheter system placed artery across overinflation intraaneurysmal herniation compliant necessary protection its capability can limited when orifice poorly covered. As branch-selective (BT), including both catheter-assisted through branch, excessively shaped microguidewire usually does not meet required accessing incorporated, easily passes toward dome. access restricted avoid risk Therefore, purpose NT requires sustainable smaller coil frame leave enough room neck whereas BT necessitates special methods manipulations safely superselect branch. Recently, our institution set up biplane three-dimensional imaging procedures, case wide-necked branch-incorporated aneurysm, we efforts at finding how smoothly on case-by-case basis. We sought evaluate technical success rate, complications, new neurological deficits