New Pipeline™ Vantage with Shield technology treatment with RIST™ radial system

CASE PRESENTATION

• 36-year-old female patient.
• MRI was performed due to dizziness. 
• Supraclinoid aneurysms on both carotid internal arteries were discovered. The one on the right was bigger. 
• Previous MRI in 2014 with no aneurysm findings.

TREATMENT STRATEGY

• Radial artery size checked with ultrasound

• Peri-arterial tissue was infiltrated with 1-2 ml 1% Lidocaine.

• Guidewire advance was well visualized in ultrasound
• 20 G needle / 0.025 hydrophilic guidewire / 7F Glidesheath isheath (Terumo)
• ”Antispasm” cocktail after insertion of the sheath: Verapamil (2.5 mg) and Heparin (2500 IU)

TECHNIQUE WITH RIST™

• Medtronic RIST™ 5 Fr SIM2 130cm select catheter is telescoped inside a Medtronic RIST™ 079 100cm guide catheter with a Terumo 0.035 wire.
• The select catheter is hooked at the CCA origin and 079 RIST™ guide is advanced directly into the petrous ICA.
• Navien 058 distal access catheter was advanced over a 027 Phenom microcatheter with a Synchro (Stryker) guidewire.

• Easy access to the right common carotid is with the select catheter.

• Sim&Size simulation was performed using the acquired 3D data.
• Pipeline™ Vantage 4x16 mm was chosen.
• The patient had started Prasugrel 5 mg and ASA 100 mg prior to the procedure.
• B-MPADP was 30.

• Roadmap saved image during the opening of the device. Vantage is well visualized.
• The opening was performed mostly by pushing the device out of the microcatheter.

• Video shows the easy and reliable opening of the proximal part of the Pipeline™ Vantage Shield.

• After opening the device, the Phenom 027 microcatheter is advanced over the pusher wire through the device to achieve full wall apposition. 

• The final run shows the nice opening of the device and contrast stagnation in the aneurysm sac.

RESULTS

• The patient continues with Prasugrel 5 mg and ASA 100 mg.
• FU DSA after 3 months.
• The patient was discharged the following day.

 This case is sponsored by Medtronic.