Neurointervention.  2011 Aug;6(2):95-99. 10.5469/neuroint.2011.6.2.95.

Z-Shaped Microcatheter Tip Shaping for Embolization of Aneurysms at the Proximal A1 Segment of the Anterior Cerebral Artery: A Technical Note

• Lee HY
• Ahn JS
• Suh DC
• Lee DH

• KMID: 1783990
• DOI: http://doi.org/10.5469/neuroint.2011.6.2.95

Abstract

Embolization of an aneurysm at the proximal A1 segment of the anterior cerebral artery (ACA) is technically challenging. We treated four consecutive patients with unruptured aneurysms at the proximal portion of the A1 segment of the ACA. We tested various microcatheter tip shapes before we successfully embolized a lesion with a zigzag-shaped microcatheter tip, which was made by steam shaping. The shape of this microcatheter tip resembled the letter "Z", had a relatively long distal straight segment and was helpful in prompt catheterization of the aneurysm sac and stable placement of the catheter and delivery of coils.

Keyword

Anterior cerebral artery; Endovascular techniques; Intracranial aneurysms; Catheters

MeSH Terms

Aneurysm
Anterior Cerebral Artery
Catheterization
Catheters
Endovascular Procedures
Humans
Intracranial Aneurysm
Steam
Steam

Figure

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  Fig. 1 Case 1, A 59-year-old female.A, B. Anterior-posterior (AP) and lateral right carotid angiogram with 3D reconstruction demonstrating posteriorly projecting saccular aneurysm arising at right proximal A1 segment of ACA.

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  Fig. 2 Case 2, 52-year-old female. Catheterization of aneurysm sac was achieved using a steam-shaped microcatheter in a "S-shape", but compact packing of the aneurysm was not possible due to early kick-back of the microcatheter.

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  Fig. 3 Case 3, 59-year-old male.A. The photograph of a steam-shaped distal microcatheter tip in "zigzag-shape" shows more acute angles, and straighter and longer distal segment than usual "S" shape.B, C. AP and lateral road-map images. Successful catheterization of aneurysm sac was achieved using a microcatheter steam-shaped in a "zigzag-shape" and subsequent compact coil packing was followed with stable microcatheter position.

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  Fig. 4 Case 4, 60-year-old male.A, B. AP and lateral road-map images. The aneurysm arises in right proximal A1 ACA, in a rather higher position when compared with the main axis of the terminal segment of the ICA on lateral view. Stable coil packing was possible with steam-shaping of the microcatheter in modified "zigzag-shape".C. We modified the the tip shaping according to the main direction of the aneurysm sac, because the axis of aneurysm was rather higher from the terminal ICA bifurcation in this case.

Reference

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