One&Done coiling for tiny aneurysms

Patient situation

• Female, 50 years old
• GCS 15, 1st DSA and 3D DSA show:
  • Absence of right A1
  • Tiny ruptured Acom aneurysm
  • Tiny AchoA aneurysm

CTA MIP Acom aneurysm

CTA MIP AchoA aneurysm

Pre-treatment: SAH at basal CT

Treatment chosen

Coiling of the ruptured Acom aneurysm

• Access material: 5F guiding catheter & Headway duo 167 microcatheter (Microvention) with Hybrid1214D guidewire (Balt Extrusion)
• Only one large volume coil: optiMAX complex supersoft 1x2 (Balt)

Coiling of the AchoA aneurysm

• Access material: Headway duo 167 microcatheter (Microvention) with hybrid1214D guidewire (Balt Extrusion)
• One large volume coil: optiMAX complex supersoft 1.5x3 (Balt)
• One large volume coil: optiMAX complex supersoft 1x1 (Balt)

Results

DSA post procedure

2 weeks control

MRA TOF 9-month control

Tiny aneurysms represent a challenging choice for endovascular strategy (coiling, balloon, stent, flow diverter).

Simple coiling is still the best option to treat a ruptured aneurysm, excluding complications related to antiplatelet therapy when using devices like stents and flow diverters.

Using larger diameter and softer coils like optiMAX coils allows filling the aneurysm with less coils, which is helpful in both treatment of big aneurysms and small aneurysms.

Moreover, the pusher technology of optiMAX offers stability and minimizes kickback, which is useful in every condition but even more in challenging cases, such as tiny aneurysms.

To conclude, One&Done coiling is an elegant and efficient treatment strategy that could be facilitated using larger volume coils.

Supported by Balt