Abstract
The management of ruptured, large and giant wide-necked aneurysms of the anterior circulation is challenging. Treatment options include balloon-assisted coiling versus flow-diverter-assisted coiling. In this technical video, https://drive.google.com/file/d/1EtyrJv3e5Z0XM2pYBNNBHVUdYwavlTFh/view?usp = sharing we demonstrate a case of a right-sided paraclinoid aneurysm in a young man who presented with post-coital sudden-onset headache. The computed tomography scan showed a Fisher grade IV subarachnoid hemorrhage. An external ventricular drain was placed, and the patient was intubated for prompt treatment. Balloon-assisted coiling of the aneurysm was attempted but abandoned because the balloon failed to provide adequate coverage of the aneurysm neck. A loading dose of aspirin and ticagrelor (Brilinta, Astra Zeneca, Cambridge, United Kingdom) was administered, and Pipeline embolization device (Medtronic, Dublin, Ireland)-assisted coiling was then performed for adequate occlusion of the aneurysm sac. The 6-month follow-up angiogram showed complete obliteration of the aneurysm. The technical video succinctly demonstrates the technical nuances of the procedure.
Video legend
Demonstration of the performance of and technical nuances associated with flow-diverting stent-assisted coiling of a ruptured carotid wall aneurysm.
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Footnotes
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Funding
No funding was received for this research.
Contributors
Conception and design: AHS, MW; Acquisition of data: AM, MW Analysis and interpretation of data: All authors; Drafting the abstract: AM, MW; Preparing the video: AM, MW, AHS; Critically revising the abstract and video: All authors; Reviewed submitted version of abstract and video: All authors; Statistical analysis: Not applicable.
Disclosures
MW, AM, FA, WM-D—No disclosures.
JMC—Consulting Fees: Cerenovus, J&J Medical Device Companies; Integra Lifesciences, Corp.; MIVI Neuroscience, Inc.; Penumbra, Inc.; Stryker, Corp. Support for attending meetings and/or travel: Stryker, Corp.; Penumbra, Inc.
AHS—Consulting fees: Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus, Cerevatech Medical, Inc., Cordis, Corindus, Inc., Endostream Medical, Ltd, Imperative Care, InspireMD, Ltd, Integra, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro, Inc., Peijia Medical, Penumbra, Q’Apel Medical, Inc., Rapid Medical, Serenity Medical, Inc., Silk Road Medical, StimMed, LLC, Stryker Neurovascular, Three Rivers Medical, Inc., VasSol, Viz.ai, Inc. Leadership or fiduciary role in other board, society, committee or advocacy group: Secretary – Board of the Society of NeuroInterventional Surgery 2020–2021, Chair –Cerebrovascular Section of the AANS/CNS 2020-2021. Stock or stock options: Adona Medical, Inc., Amnis Therapeutics, Bend, IT Technologies, Ltd, BlinkTBI, Inc, Cerebrotech Medical Systems, Inc., Cerevatech Medical, Inc., Cognition Medical, CVAID Ltd, E8, Inc., Endostream Medical, Ltd, Galaxy Therapeutics, Inc., Imperative; Care, Inc., InspireMD, Ltd, Instylla, Inc., International Medical Distribution Partners, Launch NY, Inc.; Neurolutions, Inc., NeuroRadial Technologies, Inc., NeuroTechnology Investors, Neurovascular Diagnostics, Inc., Peijia; Medical, PerFlow Medical, Ltd, Q’Apel Medical, Inc., QAS.ai, Inc., Radical Catheter Technologies, Inc., Rebound Therapeutics Corp. (Purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular, Inc. (Purchased 2020 by Medtronic), Sense Diagnostics, Inc., Serenity Medical, Inc., Silk Road Medical, Sim & Cure, SongBird Therapy, Spinnaker Medical, Inc., StimMed, LLC, Synchron, Inc., Three Rivers Medical, Inc., Truvic Medical, Inc., Tulavi Therapeutics, Inc., Vastrax, LLC, VICIS, Inc., Viseon, Inc. Other financial or non-financial interests: National PI/Steering Committees: Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE and SWIFT DIRECT Trials; MicroVention FRED Trial & CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, INVEST Trial, MIVI neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; InspireMD C-GUARDIANS IDE Pivotal Trial.
Data availability
Data that support the findings of this report are available from the corresponding author on reasonable request.
Ethics
Our patient provided informed consent for treatment and HIPAA-compliant publication. The University at Buffalo Institutional Review Board does not require approval for a technical report involving a single case.
Supplemental Material
Supplemental material for this article is available online.
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