Geoffrey W Peitz1, Bhavani Kura1, Jeremiah N Johnson2, Ramesh Grandhi1. 1. Department of Neurosurgery, University of Texas Health Science Center, San Antonio, TX, USA. 2. Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
Abstract
BACKGROUND: Flow diversion with the Pipeline embolization device (PED) is an effective treatment for giant and wide-neck intracranial aneurysms, but the standard transfemoral approach may not be feasible in patients with Type-3 aortic arches. CASE REPORT: An 84-year-old woman presented with a right internal carotid artery (ICA) giant aneurysm and a Type-3 aortic arch, necessitating a transradial approach for access to the right common carotid artery. A triaxial catheter system made for a stable platform for the deployment of two telescoping PEDs to treat the patient's right ICA giant aneurysm. The procedure was technically successful, and there were no immediate complications. CONCLUSION: The transradial approach allows for carotid access in patients with challenging aortic arches, and this report demonstrates its effectiveness for deployment of flow diverters, especially with a triaxial catheter system. The peripheral access point facilitates hemostasis, which is of great importance in patients on antiplatelet medications to prevent thrombotic complications of flow diverters.
BACKGROUND: Flow diversion with the Pipeline embolization device (PED) is an effective treatment for giant and wide-neck intracranial aneurysms, but the standard transfemoral approach may not be feasible in patients with Type-3 aortic arches. CASE REPORT: An 84-year-old woman presented with a right internal carotid artery (ICA) giant aneurysm and a Type-3 aortic arch, necessitating a transradial approach for access to the right common carotid artery. A triaxial catheter system made for a stable platform for the deployment of two telescoping PEDs to treat the patient's right ICA giant aneurysm. The procedure was technically successful, and there were no immediate complications. CONCLUSION: The transradial approach allows for carotid access in patients with challenging aortic arches, and this report demonstrates its effectiveness for deployment of flow diverters, especially with a triaxial catheter system. The peripheral access point facilitates hemostasis, which is of great importance in patients on antiplatelet medications to prevent thrombotic complications of flow diverters.
Authors: Stephanie C Lin; Susan M Trocciola; Jason Rhee; Rajeev Dayal; Rabih Chaer; Nicholas J Morrissey; Leila Mureebe; James F McKinsey; K Craig Kent; Peter L Faries Journal: Ann Vasc Surg Date: 2005-11 Impact factor: 1.466
Authors: David O Wiebers; J P Whisnant; J Huston; I Meissner; R D Brown; D G Piepgras; G S Forbes; K Thielen; D Nichols; W M O'Fallon; J Peacock; L Jaeger; N F Kassell; G L Kongable-Beckman; J C Torner Journal: Lancet Date: 2003-07-12 Impact factor: 79.321
Authors: Russell C Lam; Stephanie C Lin; Brian DeRubertis; Robert Hynecek; K Craig Kent; Peter L Faries Journal: J Vasc Surg Date: 2007-05 Impact factor: 4.268
Authors: Surabhi Madhwal; Vivek Rajagopal; Deepak L Bhatt; Christopher T Bajzer; Patrick Whitlow; Samir R Kapadia Journal: J Invasive Cardiol Date: 2008-05 Impact factor: 2.022
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