A 73-year-old female, with balance disturbances and a history of hypertension and hemochromatosis is discovered on MRI to have an unruptured non-thrombosed right ICA aneurysm. From LINNC Paris 2019, join Prof. Jacques Moret and the international expert panel for a “live” case by Prof. Laurent Spelle and the Neuri Paris team as they treat a carotid siphon aneurysm with a small “daughter sac” using a new Stryker EVOLVE flow diverter. Follow every step in the process from looking at the initial angiograms, defining the relationship with the carotids and PCOMs and determining whether the ophthalmic artery is included in the sac or the neck of the aneurysm itself.
With the data visualized using Sim & Cure software, see how this program allows for the precise sizing of the EVOLVE device, aiding in planning the approach and making it possible for the operators to see, in advance, the levels of wall apposition. In addition, with the use of 3D roadmaps, routine at the Neuri Center, imaging technology helps fix the landing zone for the stent.
Different aspects concerning the techniques employed in the placement of the EVOLVE are discussed. Prof. Spelle chooses to place the device proximal to the anterior choroidal artery: why doesn’t he want to cover the origin of this artery with the flow diverter? As a braided stent, what is the effect of “push”? Also, in this case, the flow diverter is not deployed, but placed directly in position on compression; in other instances, however, flow diverters can be delivered by stretching as well.
Would you consider coiling in this case? Why would flow diverters be a first choice? Is there a size or type of the aneurysm that could make you choose to coil or not? Could involvement with the ophthalmic artery or risk of bleeding influence the decision to use coils? What about flow diversion in larger, “giant” aneurysms (2.5 cm) where complications can occur?
What do you think? Watch this case report now….
This LIVE case corresponds to the highest ethical standards in medicine and is posted on LINNC Online for educational purposes only to allow medical professionals to improve their knowledge about these procedures and how to best treat their patients.