Tiger 13 Stentectomy

Watch every step of this Tiger 13 Stentectomy performed by Dr. Vladimir Kalousek, Dr. Branimir Čulo, Dr. Ante Rotim and Dr.Josip Savić (KBC Sestre Milosrdnice, Croatia).

Case

Female patient (1955), SAH in June 2020 recovered from GCS 3 to GCS 15, no deficit
Coiling of ACM aneurysm, microaneurysm on lentriculostriatal artery observation
Control DSA at 3 months, showed recurrence at the neck of ruptured aneurysm, and treatment with recoiling and stent placement was planned

Coiling of the neck was performed. To increase good result, placement of atlas through m2 into m1 was done, patient was on DAPT for 5 days beforehand and levels of aggregation were satisfactory.

Closing of distal part of atlas was noticed, as well as occlusion of parietal branch from neck of the aneurysm.
Bolus dosage of IA integrilin was applied as well as an increase in IV aspirin.
During wait, thrombosis was increasing, so PTA with scepter XC was performed to ensure proper apposition on vessel wall, but during the waiting period again thrombosis was noticed.
Not wanting to risk occlusion of whole branch, stentectomy with tiger 13 was performed.

Atlas was crossed with headway duo through which tiger 13 was opened at distal portion and beyond
Tiger 13 was slowly released while pinching proximal part with microcath.
When it was noticed that tiger caught atlas, advancement of navien 072 was made into m1, as well as ballast guide almost to ophthalmic segment.
Then, navien with tiger and atlas were pulled into ballast
Control run, as well as dyna CT, were made to ensure there was no bleeding
Occlusion of the branch at the neck was still present but on lateral images, due to cortical leptomeningeal anastomosis filling was retrograde.
Patient was awakened, with minor hand paresis which resolved next day.

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