Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU
Embolization of Wide-neck MCA Embolization of Wide-neck MCA Bifurcation Aneurysm using Dual Bifurcation Aneurysm using Dual Microcatheter and Flow Diversion Microcatheter and Flow Diversion
TechniqueTechnique
Department of Neurosurgery, Changhai Hospital, SMMU
Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU
Case Report
• 55-year-Old Female
• Complaining of headache for 3 weeks
• Intracranial aneurysm incidentally found by MRI 2 weeks before admission.
• PE: Nothing significant
Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU
MR
Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU
CTA
• Acom aneurysm
• MCA bifurcation aneurysm, wide-neck, both trunks involved in the neck region
Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU
DSA
MCA bifurcation aneurysm wide-neck both trunks involved in the neck region
Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU
Dual Microcatheter tech.
• Partially embolized
Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU
Dual Microcatheter tech.
• Patency of both trunks was maintained
Superior trunk
Inferior trunk Inferior trunk
Superior trunk
Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU
Stent deployment
• Microcatheter advanced through the acute angle between M1 & superior trunck to M2 under the support of coils in the dome.
Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU
Stent deployment
• Rebar-18
• Solitaire 4/20
Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU
Post-embolization
• Raymond II
• Both trunks of MCA patent
Superior trunk
Inferior trunkInferior trunk
Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU
Flow diversion by stent
• Curvature between M1-M2 (superior trunk)
decreased in the same working projection
pre-embo. post-embo.
Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU
Follow up angio.
• 2-month-follow up angio.
Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU
CFD
Pre-stenting Post-stenting
Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU
CFD
Pre-stenting Post-stenting