Tools and TechniquesWEB as a combined support and embolization device in a giant partially thrombosed donut-shaped aneurysm
Introduction
Giant partially thrombosed aneurysms are challenging lesions where treatment must be considered because of their poor natural history and bad prognosis [1]. Endovascular blood flow exclusion has progressively gained importance and is now the first line treatment in most cases. Secure navigation and catheterization of target arteries, which is an essential prerequisite for endovascular treatment, is particularly challenging not only due to their unfavourable anatomical configuration but also to abnormal flow conditions which worsen the microcatheter and microwire navigation conditions.
Section snippets
Case presentation
A 49 years-old woman was diagnosed with a giant partially thrombosed aneurysm of the left-sided supraophthalmic internal carotid artery (ICA) when referred for a brain MRI for persisting headaches. Apart from the headaches, the patient was asymptomatic. The pre-interventional 3D rotational angiography permitted to further characterize the aneurysm, which showed a size of 27 × 21 × 10 mm and a donut shape due to a centrally located intraluminal thrombus (Fig. 1A–C). After multidisciplinary
Discussion
Super-selective catheterization of an aneurysm and the blood vessels adjacent to it can be challenging due to anatomical and blood flow related conditions. Its failure is one of the leading causes of unsuccessful endovascular procedures.
Donut-shaped aneurysms, which are characterized by organized intraluminal thrombus, are particularly challenging lesions due to not only to their unfavourable anatomical configuration but also due to abnormal intrasaccular blood flow conditions which in our case
Ethical approval statement
Written informed consent for publishing this case report was provided by the patient.
Declaration of Competing Interest
DFV has received travel support outside this work from MicroVention and Stryker GmbH & Co. KG. MB reports board membership: DSMB Vascular Dynamics; consultancy: Roche, Guerbet, Codman; grants/grants pending: DFG, Hopp Foundation, Novartis, Siemens, Guerbet, Stryker, Covidien; payment for lectures (including service on speakers bureaus): Novartis, Roche, Guerbet, Teva, Bayer, Codman. MAM has received consulting honoraria, speaker honoraria, and travel support outside this work from Codman,
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