Kirill Orlov1, Anil Arat2, Alexander Osiev3, Vadim Berestov4, Kudret Aytemir5, Mehmet Akif Topcuoglu6, Ethem Murat Arsava6. 1. E.N. Meshalkin Siberian Federal Biomedical Research Center, Novosibirsk, Russian Federation; Novosibirsk State Medical University, Novosibirsk, Russian Federation. 2. Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey. Electronic address: anilarat@hotmail.com. 3. Moscow Regional Research and Clinical Institute ("MONIKI"), Moscow, Russian Federation. 4. E.N. Meshalkin Siberian Federal Biomedical Research Center, Novosibirsk, Russian Federation. 5. Department of Cardiology, Hacettepe University Hospitals, HUTF Kardiyoloji ABD, Ankara, Turkey. 6. Department of Neurology, Hacettepe University Hospitals, HUTF Noroloji ABD, Ankara, Turkey.
Abstract
BACKGROUND: Transseptal puncture has been widely used by cardiologists to reach the left side of the heart through a transvenous access. Rarely, it also can be used to pass into the supra-aortic arteries from the venous side when conventional transarterial access pathways (transfemoral, transradial/brachial routes, or direct carotid puncture) are likely to fail. CASE DESCRIPTION: We report 2 cases of transvenous femoral access followed by transseptal access to aorta to treat dissecting carotid artery aneurysms at the level of the skull base with flow diverters. In one case, multiple cervical arterial bypass operations and in the other a rare anomaly of the aortic arch precluded endovascular treatment through conventional routes. CONCLUSIONS: Transvenous-transseptal access enabled treatment of both cases easily and without complications. On follow-up computed tomography angiograms, both flow diverters were patent, there were no residual aneurysms, and no neurologic or cardiac adverse events in either patient.
BACKGROUND: Transseptal puncture has been widely used by cardiologists to reach the left side of the heart through a transvenous access. Rarely, it also can be used to pass into the supra-aortic arteries from the venous side when conventional transarterial access pathways (transfemoral, transradial/brachial routes, or direct carotid puncture) are likely to fail. CASE DESCRIPTION: We report 2 cases of transvenous femoral access followed by transseptal access to aorta to treat dissecting carotid artery aneurysms at the level of the skull base with flow diverters. In one case, multiple cervical arterial bypass operations and in the other a rare anomaly of the aortic arch precluded endovascular treatment through conventional routes. CONCLUSIONS: Transvenous-transseptal access enabled treatment of both cases easily and without complications. On follow-up computed tomography angiograms, both flow diverters were patent, there were no residual aneurysms, and no neurologic or cardiac adverse events in either patient.