Large neck anterior communicating artery aneurysm: An unusual approach

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.

Case

CASE PRESENTATION

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

NON-CONTRAST CT BRAIN

You do not have permission to view this object.

INITIAL RUN

ANEURSYM MORPHOLOGY

LEFT SIDE ICA ANGIOGRAM

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.

DEVICE SELECTION

NAVIGATION

VIA 33 x A1 SEGMENT

You do not have permission to view this object.

VIA 33

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

TWO 0,014" GUIDEWIRE

You do not have permission to view this object.

A1 NAVIGATION

You do not have permission to view this object.

ANEURYSM CATHETERIZATION

You do not have permission to view this object.

DEVICE DEPLOYMENT

You do not have permission to view this object.

DETACHMENT

You do not have permission to view this object.

CONTROL ANGIO

You do not have permission to view this object.

3 MONTHS FOLLOW-UP

Bicêtre Occlusion Scale Score (BOSS) = 0.

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.