INR scope

MMA embolization of a 96-year-old patient

Author: Yaniv Gal

Find out how Dr Gal Yaniv treated this case performing a staged MMA embolization.

Friday 19 May 2023
  • Case presentation


    • 96-year-old female patient mRs 1. Known to have HTN, DM II, and moderate pulmonary hypertension as well as take Aspirin for primary prevention
    • Was admitted to Neurosurgery after general deterioration for the last month, with a recent fall.
    • NCCT for the ER has demonstrated bilateral large cSDH.


    PRE – Embolization CT



    The neurosurgery team decided not to perform cSDH evacuation due to the fragility of the patient as well the absence of any laterality of neurological symptoms.

    A decision was made to perform a staged MMA embolization. The first side was the left.

    The first session was performed using:

    • 6 Fr femoral sheath
    • 6 Fr EnvoyTM
    • PhenomTM PLUS DAC
    • ApolloTM 1.5 3 cm
    • HybridTM 007 microwire



    The EnvoyTM was placed in the RT CCA.

    After choosing optimal A and B positions, a Bi-axial system composed of PhenomTM Plus over an ApolloTM microcatheter over a HybridTM microwire was advanced into the dominant anterior branch of the MMA.

    After verifying the second marker of the ApolloTM microcatheter was placed above the petrous branch origin, 0.2 cc of OnyxTM 18 was injected with proximal occlusion of the branch. The microcatheter was withdrawn.

    The control angiogram did not demonstrate the MMA.

    The procedure was concluded with no complications.


    OnyxTM 18 cast


    Further management

    • The patient was brought two weeks later for embolization of the LT MMA.
    • Technique was identical.


  • Follow up

    6 weeks follow-up – CT


    6 months follow-up – CT



    This case is sponsored by Medtronic.

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