INR scope

Large neck anterior communicating artery aneurysm: An unusual approach

Author: ALMEIDA SILVA João Miguel

Find out how Dr. João Miguel de Almeida Silva (CDNI, São Paulo - Brazil) treated a 64-year-old male patient suffering from a large neck anterior communicating artery aneurysm.

Monday 14 March 2022
  • Case

    CASE PRESENTATION

    • 64-year-old male.
    • Smoker – 40 years.
    • High blood pressure.
    • Coronariopathy.
    • Transient ischemic attack 6 months ago.

     

    NON-CONTRAST CT BRAIN

     

     

    Large neck anterior communicating artery aneurysm : Non contrast CT brain - You do not have permission to view this object.

     

    INITIAL RUN

     

    aneurysm

     

    ANEURSYM MORPHOLOGY

     

    aneurysm

     

    LEFT SIDE ICA ANGIOGRAM

     

    aneurysm

     

    TREATMENT OPTIONS

    • Coil.
    • Coil + Remodeling.
    • Coil + stent.
    • Unilateral flow diverter (A2-A1).
    • AcomA flow diverter.
    • Bilateral flow diverter (A2-A1).
    • Intrasaccular device.

     

    CASE

    • Unruptured Acom aneurysm.
    • Neck – 4,2mm.
    • Smallest aneurysm height – 11,5mm.
    • Average aneurysm width – 8,5mm.

     

    aneurysm

     

    DEVICE SELECTION

     

    aneurysm

     

    NAVIGATION

     

    aneurysm

     

    VIA 33 x A1 SEGMENT

     

     

    Large neck anterior communicating artery aneurysm : VIA 33 x A1 segment - You do not have permission to view this object.

     

     

    aneurysm

     

    VIA 33

    • 0,033 inch ID.
    • Specifically engineered reinforced distal portion.
    • Allows device recapture and redeployment.

     

    aneurysm

     

    TWO 0,014" GUIDEWIRE

     

    aneurysm

     

    aneurysm

     

     

     

     

    Large neck anterior communicating artery aneurysm: Two 0,014” guidewire - You do not have permission to view this object.

     

     

    A1 NAVIGATION

     

     

    Large neck anterior communicating artery aneurysm: A1 navigation - You do not have permission to view this object.

     

     

    ANEURYSM CATHETERIZATION

     

     

    Large neck anterior communicating artery aneurysm: Aneurysm catheterization - You do not have permission to view this object.

     

     

    DEVICE DEPLOYMENT

     

    Large neck anterior communicating artery aneurysm: device deployment - You do not have permission to view this object.

     

    Large neck anterior communicating artery aneurysm: device deployment 2 - You do not have permission to view this object.

     

    aneurysm

     

    DETACHMENT

     

    Large neck anterior communicating artery aneurysm: detachment - You do not have permission to view this object.

     

     

    CONTROL ANGIO

    Large neck anterior communicating artery aneurysm: control angio 1 - You do not have permission to view this object.

     

    Large neck anterior communicating artery aneurysm: control angio 2 - You do not have permission to view this object.

     

    aneurysm

     

     

     

    Large neck anterior communicating artery aneurysm: final control angio - You do not have permission to view this object.

     

     

    3 MONTHS FOLLOW-UP

    • Bicêtre Occlusion Scale Score (BOSS) = 0.

     

    aneurysm

     

    aneurysm

     

     

    TAKE HOME MESSAGE

    • WEB can be an option for aneurysms ≥ 10mm.
    • VIA 33 has a specifically engineered reinforced distal portion that allows the device`s recapture and redeployment but can make catheterization harder.
    • Sometimes, navigation could be the most complex step of the procedure.
    • Two 0,014” guidewires can be an alternative when using a 0,033” ID microcatheter.
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