Neurointervention.  2022 Jul;17(2):115-120. 10.5469/neuroint.2022.00136.

Parent Artery Complex Coil Protection for Side-Branched Wide-Neck Aneurysms

• Sato K
• Aoki H
• Jinguji S
• Seto H
• Kobayashi T

• KMID: 2531568
• DOI: http://doi.org/10.5469/neuroint.2022.00136

Abstract

This study aimed to validate the usefulness of parent artery complex coil protection for the treatment of wide-neck, side-branched, and ruptured aneurysms. A microcatheter was first introduced into the aneurysmal sac, and another microcatheter was introduced into the parent artery or near the orifice of the branch artery. A framing coil was deployed partially from the first microcatheter, and a protection coil was deployed from the second microcatheter to prevent protrusion of the first framing coil to the parent artery and side branches. After the first framing coil insertion, the protection coil was withdrawn to confirm the stability of the framing coil and blood flow. The procedures with this technique were successful for 3 patients. Parent artery complex coil protection can be an effective and safe coil embolization technique for the preservation of parent and side branch arteries and an alternative method for emergent ruptured cases.

Keyword

Catheters; Endovascular technique; Ruptured aneurysm

Figure

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  Fig. 1. Schematic of the parent artery coil protection technique for the side-branched aneurysm. (A) Because of the wide neck, the first framing coil protrudes into the side branch and parent artery. (B) The first framing coil is inserted into the aneurysm sac and is stable with a protective coil from the second microcatheter. (C) After withdrawing the protective coil, the stability of the framing coil should be confirmed.

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  Fig. 2. (A, B) Working views of the right internal carotid angiograms show a wide neck IC-PC aneurysm. (C) First framing coil was inserted with the parent artery coil protection from the second microcatheter (white arrow). (D, E) Right internal carotid angiograms after the procedure show good preservation of the posterior communicating artery. (F) Postoperative magnetic resonance DWI shows spotty hyperintense areas, but there were no symptoms. IC-PC, internal carotid-posterior communicating artery; DWI, diffusion-weighted imaging.

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  Fig. 3. (A, B) Working views for the left vertebral angiograms show a very wide-neck BA tip aneurysm. (C) First framing coil was inserted with the protection of the coil loops (between white arrows) from the second microcatheter. (D) After withdrawing the protection coil, the stability of the framing coil was confirmed. The white arrow shows the second microcatheter tip. (E, F) Left vertebral angiograms after the procedure show good preservation of the bilateral PCA and SCA. The white arrows show good obliteration of the ruptured bleb. BA, basilar artery; PCA, posterior cerebral artery; SCA, superior cerebellar artery.

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