BACKGROUND AND IMPORTANCE: Flow diversion with the pipeline embolization device (PED) is an emerging endovascular technology allowing curative embolization of very large and giant intracranial aneurysms. Many patients with these complex aneurysms are older. The presence of a tortuous type III aortic arch reduces the chances of successful PED delivery and increases the risk of complications. We report 2 technical nuances regarding the delivery of the PED in older patients with a complex aortic arch. CLINICAL PRESENTATION: In case 1, an 87-year-old woman presented with acute-onset left third nerve palsy. Workup demonstrated an 18-mm left posterior carotid wall aneurysm with a large daughter aneurysm on its dome. Endovascular access was complicated by a type III aortic arch with a hyperacute angle at the origin of the left common carotid artery. An 8F Simmons II shaped guide formed a stable platform, allowing successful PED delivery. In case 2, a 76-year-old woman experienced a transient ischemic attack. She harbored a right-sided 20-mm cavernous internal carotid artery aneurysm. She was treated with 2 PEDs deployed via a transradial approach. CONCLUSION: Transradial access or guide support with the 8F Simmons II catheter grants stable access for curative embolization with the PED in elderly patients with a large intracranial aneurysm and a complex aortic arch.
BACKGROUND AND IMPORTANCE: Flow diversion with the pipeline embolization device (PED) is an emerging endovascular technology allowing curative embolization of very large and giant intracranial aneurysms. Many patients with these complex aneurysms are older. The presence of a tortuous type III aortic arch reduces the chances of successful PED delivery and increases the risk of complications. We report 2 technical nuances regarding the delivery of the PED in older patients with a complex aortic arch. CLINICAL PRESENTATION: In case 1, an 87-year-old woman presented with acute-onset left third nerve palsy. Workup demonstrated an 18-mm left posterior carotid wall aneurysm with a large daughter aneurysm on its dome. Endovascular access was complicated by a type III aortic arch with a hyperacute angle at the origin of the left common carotid artery. An 8F Simmons II shaped guide formed a stable platform, allowing successful PED delivery. In case 2, a 76-year-old woman experienced a transient ischemic attack. She harbored a right-sided 20-mm cavernous internal carotid artery aneurysm. She was treated with 2 PEDs deployed via a transradial approach. CONCLUSION: Transradial access or guide support with the 8F Simmons II catheter grants stable access for curative embolization with the PED in elderly patients with a large intracranial aneurysm and a complex aortic arch.
Authors: Yangchun Li; Stephanie H Chen; Alejandro M Spiotta; Pascal Jabbour; Michael R Levitt; Peter Kan; Christoph J Griessenauer; Adam S Arthur; Joshua W Osbun; Min S Park; Nohra Chalouhi; Ahmad Sweid; Stacey Q Wolfe; Kyle M Fargen; Aaron S Dumont; Travis M Dumont; Marie-Christine Brunet; Samir Sur; Evan Luther; Allison Strickland; Dileep R Yavagal; Eric C Peterson; Clemens M Schirmer; Oded Goren; Shamsher Dalal; Gregory Weiner; Axel Rosengart; Daniel Raper; Ching-Jen Chen; Peter Amenta; Tyler Scullen; Cory Michael Kelly; Christopher Young; Michael Nahhas; Eyad Almallouhi; Arunprasad Gunasekaran; Suhas Pai; Giuseppe Lanzino; Waleed Brinjikji; Mehdi Abbasi; David Dornbos Iii; Nitin Goyal; Jeremy Peterson; Mohammad H El-Ghanem; Robert M Starke Journal: J Neurointerv Surg Date: 2020-06-02 Impact factor: 5.836
Authors: A L Kühn; S R Satti; T Eden; K de Macedo Rodrigues; J Singh; F Massari; M J Gounis; A S Puri Journal: AJNR Am J Neuroradiol Date: 2021-01-14 Impact factor: 3.825
Authors: Muhammad Waqas; Kunal Vakharia; Rimal H Dossani; Gary B Rajah; Michael K Tso; Andrew D Gong; Kyungduk Rho; Hamid H Rai; Kenneth V Snyder; Elad I Levy; Adnan H Siddiqui; Jason M Davies Journal: Interv Neuroradiol Date: 2020-07-05 Impact factor: 1.610