MMA embolization of a 96-year-old patient

Patient

• 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

Management

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 Envoy^TM
• Phenom^TM PLUS DAC
• Apollo^TM 1.5 3 cm
• Hybrid^TM 007 microwire

Technique

The Envoy^TM was placed in the RT CCA.

After choosing optimal A and B positions, a Bi-axial system composed of Phenom^TM Plus over an Apollo^TM microcatheter over a Hybrid^TM microwire was advanced into the dominant anterior branch of the MMA.

After verifying the second marker of the Apollo^TM microcatheter was placed above the petrous branch origin, 0.2 cc of Onyx^TM 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 The microcatheter was withdrawn.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.

6 weeks follow-up – CT

6 months follow-up – CT

This case is sponsored by Medtronic.