Using radial access for multiple interventions during one procedure.
Woman with incidental finding of three aneurysms on examination for stroke. mRS 1. Klippel-Trénaunay.
Preparation for the intervention
Seven days before, double antiplatelet therapy was prescribed and started with a loading dose of 300 mg of clopidogrel, followed by 75 mg and 100 mg of acetylsalicylic acid every 24 hours. Platelet aggregation test was not performed.
Volume rendering of the magnetic resonance angiographic sequence. Wide neck aneurysm in Anterior Communicating artery.
Volume rendering of rotational angiography. Cavernous aneurysm. Lateral visualization.
Volume rendering of rotational angiography. Cavernous aneurysm. Anterior-Posterior visualization.
Second time treatment of ACoA aneurysm. Flow-diverting stent placement was planned. Previously the left side A1-A2 was stented (PipelineTM Vantage). In this step, the right side is treated with an A1-A2 stent (Pipeline™ Vantage). Distal radial access was chosen to minimize puncture complications (the same in both procedures). An ipsilateral internal carotid artery (ICA) has been treated in this procedure by embolization with coils.
Simulation of the placement of the stent with Sim & Cure software
Simulation of the placement of the stent with Sim & Cure software.
Adequate deployment of the stent. Good apposition. Procedure ends without complications. Good evolution during admission. Discharge 48 hours after the procedure.
Obliquus angiography post-treatment of the aneurysm. The stent A1-A2 is permeable, and the flow is slow in the aneurysm sac. The cavernous aneurysm is excluded with the expected packaging simulated with the software.
This case is sponsored by Medtronic.
Pediatric ICA aneurysm