Neurointervention.  2021 Jul;16(2):175-179. 10.5469/neuroint.2021.00073.

Scepter-Mini Balloon Assisted Coil Embolization of an Intracranial Arterial Aneurysm in a Child with PHACE Syndrome via a Persistent Trigeminal Artery

• Jagadeesan BD
• IV CQ
• Masood K
• Grande A
• Tummala RP

• KMID: 2517744
• DOI: http://doi.org/10.5469/neuroint.2021.00073

Abstract

Cerebral vascular malformations constitute one of the key abnormalities in children with PHACE syndrome, which is characterized by Plaque like cutaneous hemangiomas, Posterior fossa abnormalities, arterial Cerebrovascular and Eye abnormalities, with or without Sternal clefts (PHACES when sternal clefts are present), and associated midline anomalies. Both moyamoya arteriopathy and intracranial aneurysms have been reported in children with this syndrome. Herein, we report the successful treatment of a growing left posterior-communicating artery aneurysm arising from an aberrant left internal carotid artery (LICA) with balloon assisted coiling (BAC) in a child with PHACE syndrome. We circumvented the limitations posed by the narrow caliber of the proximal LICA, by successfully navigating a coiling microcatheter from the basilar artery into the LICA via a persistent trigeminal artery. BAC was then achieved using a Scepter Mini balloon microcatheter for aneurysm neck remodelling.

Keyword

PHACE syndrome; Aneurysm; Persistent trigeminal artery; Coil embolization; Scepter mini balloon

Figure

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  Fig. 1. (A) Lateral projection from DSA obtained with simultaneous injection of the LICA and left vertebral artery showing 1. PTA (black chevron), 2. Aberrant LICA (single white arrow), 3. left PCoA aneurysm (single black arrow) and 4. Moyamoya like changes (double white arrow). (B) Anterior and (C) lateral oblique projections showing an Echelon 10 microcatheter (white arrows) advanced from the basilar artery to the LICA via the PTA, and (D) illustration showing Echelon 10 microcatheter (green line/white arrow) advanced from the basilar artery to the LICA via the PTA. (E) Anterior and (F) lateral oblique projections showing an Echelon 10 microcatheter (thin white arrows) advanced from the basilar artery to the LICA via the PTA, and a SMB advanced (thick white arrows) advanced across the neck of the PCoA aneurysm, and (G) illustration showing relative positioning of Echelon 10 microcatheter (thin white arrow) and SMB (thick white arrow). (H) Anteroposterior and (I) lateral DSA projections showing obliteration of the PCoA aneurysm by a coil mass (white arrows) with preserved flow in the parent vessel. DSA, digital subtraction angiogram; LICA, left internal carotid artery; PTA, persistent trigeminal artery; PCoA, posterior-communicating artery; SMB, Scepter Mini balloon microcatheter.

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