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ACCES A1216E DRIVER
C Send a microguidewire into the microcatheter beyond the tip of the microcatheter. D Keep the microguidewire stable and withdraw the microcatheter so that the microcatheter moves safely back along the microguidewire. Evaluation of the looping technique and clinical outcomes Acces A1216E safety of the microcatheter looping technique was assessed peri-procedurally, and the stability of the microcatheter tip was evaluated during embolization. The intra- and post-operative complications were recorded and evaluated. The degree of aneurysm occlusion was also evaluated at completion by angiography as total occlusion no residual aneurysm filling with contrast mediumnear-total occlusion minimal residual contrast at the aneurysm neckor subtotal occlusion any contrast medium in the aneurysm sac.
Clinical outcomes were evaluated with the Glasgow Outcome Scale. Follow-up angiography was performed at six and 12 months post-procedure, and the follow-up outcomes of aneurysm occlusion were categorized as follows: Results Ten cerebral aneurysms in ten patients underwent the microcatheter looping technique for aneurysm embolization.
With this looping technique, the tip of the microcatheter successfully Acces A1216E the aneurysm cavity in all ten aneurysms with access difficulty or access through the acutely angled parent artery of the aneurysm and remained stable with no kicking back during the embolization process. All the aneurysms were successfully occluded with patent parent arteries. Acces A1216E peri-procedural complications occurred.
Total occlusion was achieved in five aneurysms and near-total in five. Followed up for six Acces A1216E 12 months, all aneurysms remained in the same occlusion status except for one patient who died of acute myocardial infarction.
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Discussion This study investigated the application of the microcatheter looping technique in the treatment of cerebral aneurysms in which the parent artery formed an acute angle with the major artery or the microcatheter tip could not reach or remain stable in Acces A1216E aneurysm sac for effective embolization. The microcatheter looping technique can successfully circumvent the acute Acces A1216E formed between the aneurysm parent artery and the major artery and enable the microcatheter tip to stay steadily in the aneurysm sac, facilitating the embolization of aneurysms with access difficulty.
No peri-procedural complications occurred in this study. Endovascular embolization has been increasingly used to treat intracranial aneurysms. For most cerebral aneurysms, proper shaping of both the microguidewire and the microcatheter tips will be sufficient to navigate the microcatheter tip into the aneurysm sac for good performance. Balloon remodeling, stent protection, multiple microcatheters and microcatheter protection techniques have been used to facilitate the embolization of wide-necked aneurysms 5 - 9. However, for small caliber arteries forming an acute angle with the major artery and for some aneurysms incorporating a small artery forming an acute angle with the major artery, it is hard to navigate Acces A1216E microguidewire or the microcatheter from the major artery into the acutely angled artery for further maneuver.
For this kind of architecture, a microcatheter looping technique 12 and a balloon-guided navigation technique have been suggested for endovascular access to the acutely angled branch incorporated in the aneurysm sac. In our study, we used this microcatheter looping technique for easy navigation into the parent artery forming an acute angle with the major artery, and we also further expanded this technique to treat cerebral aneurysms in which the microcatheter tip could not stay steadily within the aneurysm sac for effective Acces A1216E.
Methods to create the distal microcatheter loop were: In the first technique in our study, we used a pre-shaped microguidewire to create the microcatheter loop and treated nine aneurysms successfully. In the second technique, we put the microcatheter tip against the ICA bifurcation wall, further advancing the microcatheter to enable the distal tip to form a loop in the M1 segment. We used these two techniques in successful treatment of six aneurysms whose parent arteries formed an acute angle with the major artery. In addition, the microcatheter looping technique was also used in one ICA clinoid aneurysm and three ophthalmic artery aneurysms. A conventional embolization technique had first been used in these aneurysms, but the microcatheter tip was Acces A1216E stable and frequently kicked out of the aneurysm sac.
Then, the microcatheter looping technique was used to increase the stability of the microcatheter tip within the aneurysm sac, and microcoils were then deployed into the sac very smoothly with good occlusion outcomes. It is easier to create the microcatheter loop within the ICA or the basal artery where the arterial diameter is large and damage to the endovascular layer of the artery is less likely. Because the MCA has a smaller caliber, vasospasm and damage to the endothelial layer readily appear if the microcatheter Acces A1216E technique is tried here. The microcatheter looping technique is suggested only when conventional techniques fail and embolization should be carefully planned beforehand so as to reduce unnecessary maneuvers as well as possible complications.
For smaller caliber arteries less than 3 mm in diameter, the microcatheter looping technique is not suggested due to possible Acces A1216E to the endothelial layer of the vessels. If it is necessary to use the microcatheter looping technique, try some softer microguidewires and microcatheters in order to reduce stimulation to the arteries and avoid vasospasm. At the end of embolization, do not directly withdraw the looped microcatheter because the microcatheter tip may move unexpectedly and perforate the aneurysm wall.
First, advance the looped microcatheter further to let the microcatheter tip out of the aneurysm sac, and then send the microguidewire beyond the microcatheter tip. The microcatheter can be safely withdrawn along the microguidewire. There are some limitations in this study.
Firstly, we only had a small cohort of patients and a large number of patients may be needed to further test the micro-catheter looping Acces A1216E. Secondly, the safety of this looping technique could not be tested for certain in this study because of the small patient cohort, although no peri-procedural complications were encountered, and Acces A1216E patients are needed for further confirmation. In conclusion, the microcatheter looping technique can be used to navigate into some acutely angled arteries and enable the microcatheter tip to remain steadily within the aneurysm sac for effective embolization of cerebral aneurysms. Endovascular treatment of wide-necked cerebral aneurysms with an acute angle branch incorporated into the sac: Graves VB.
Advancing loop technique for endovascular access to the anterior cerebral artery. The AE card uses a bit successive approximation analog-to-digital converter (A/D) with a sample and hold amplifier input. Acces A1216E ideal conditions, the.
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