Implantation of an Artisse™ intrasaccular Device for an incidental Acom aneurysm

Patient situation

A 62-year-old patient presented at an external facility with suspected stroke due to dizziness.

Acute ischemia was ruled out via MRI. The initial CTA revealed an incidental finding of an aneurysm in the Acom complex.

A week later, a diagnostic DSA was performed for therapy planning.

The 3D rotational angiography revealed a broad-based aneurysm measuring 4 mm x 5 mm x 3 mm at the transition from the prominent anterior communicating artery to the left A2 segment.

Treatment chosen

Set up

• General anaesthesia
• Right femoral artery puncture (8-French short sheath)
• NeuronMAX long sheath (6-French)
• 5-French Navien Catheter
• Headway21 Microcatheter
• 0.014” Synchro Microwire
• Artisse Intrasaccular™ Device: Sim&Size

Medication

• ASA 100mg 1-0-0
• Clopidogrel 75mg 1-0-0
• Efficacy Tested (VerifyNow™)

Artisse™ Intrasaccular Device

• 5.5 mm x 3.0 mm vs. 5.0 mm x 4.0 mm
• Aneurysmal diameter (at the middle height): 4.10
• Aneurysmal height from neck to dome: 5.71

Apposition 5.5 mm x 3.0 mm

Apposition 5.0 mm x 4.0 mm

After visualizing the anterior circulation, the Navien catheter was positioned in the distal ICA.

Working Projection

Microcatheter Position

Deployment of the Artisse™ Device

Final Result

Final Result with Contrast Stasis in the Aneurysm

Outcome

The patient recovered well after the embolization and was discharged after 3 days.

Clopidogrel was discontinued immediately, while ASA is to be continued for another 6 weeks. The patient is scheduled for a follow-up DSA in 6 months.

Flat panel CT scan

Unremarkable Post-embolization CT scan

Supported by Medtronic