Name:
10.3171/2022.7.FOCVID21152
Description:
10.3171/2022.7.FOCVID21152
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/8a950a4a-0e56-4c93-b5a9-cd375b40deb1/videoscrubberimages/Scrubber_258.jpg
Duration:
T00H05M03S
Embed URL:
https://stream.cadmore.media/player/8a950a4a-0e56-4c93-b5a9-cd375b40deb1
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/8a950a4a-0e56-4c93-b5a9-cd375b40deb1/21-152.mp4?sv=2019-02-02&sr=c&sig=pABJLmPSyTyAMpoxBJUPJp7rrtDjVLyKs9xX14uIX3g%3D&st=2024-05-04T16%3A59%3A22Z&se=2024-05-04T19%3A04%3A22Z&sp=r
Upload Date:
2022-09-12T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
[MUSIC PLAYING]
SPEAKER: We present WEB Embolization in the retreatment of a basilar apex aneurysm. The patient was a 60-year-old man who underwent treatment of his unruptured basilar apex aneurysm with the WEB SL device, sized 7 × 5 mm. Note the oversizing of the device relative to the aneurysm dimensions. At 12-month follow- up, he was noted to have significant recurrence of the aneurysm with growth around the base of the aneurysm, with compaction of the device.
SPEAKER: He remained neurologically intact on follow-up. After discussion with the patient and informed consent, we proceeded with retreatment of the aneurysm. Our setup consisted of a 6-Fr slender sheath in the right radial artery, through which a Benchmark guide catheter was inserted. A Penumbra select catheter was used to access the right vertebral artery. From there, a SOFIA 5-Fr intermediate catheter and a VIA-21 microcatheter were used to access the aneurysm and deploy a new WEB SL device.
SPEAKER: The right vertebral artery is being accessed here with the Penumbra select catheter over an 0.035 guidewire. The Benchmark guide catheter is then advanced into the mid-V2 segment. These baseline cranial runs demonstrate the recurrent basilar apex aneurysm. The 3D rotational angiogram demonstrates the anatomy at the basilar apex, with the aneurysm projecting superiorly and slightly posteriorly.
SPEAKER: A magnified AP and lateral treatment view is seen here, from which we measure the device. The aneurysm is being microcatheterized here. The wire is centered within the aneurysm as much as possible to obtain an ideal position for WEB deployment. The distal access catheter is positioned just below, providing support. Note the markers of the prior device.
SPEAKER: The new WEB device is then advanced in the microcatheter and deployed. The microcatheter position is slightly adjusted during deployment. There are several concepts to keep in mind when considering sizing of the WEB device. In general, oversizing is a preferred in WEB device selection.
SPEAKER: In flow diversion, parent artery wall apposition is the goal. In WEB flow disruption, aneurysm neck apposition is the goal. This is achieved by oversizing with lateral compression of the device. In this particular case, undersizing the device was most likely associated with the recurrence. Thus, in the retreatment, we tried to oversize for the recurrence. Because the aneurysm recurrence was smaller than the original aneurysm, a similar sized device was chosen.
SPEAKER: The recurrence rate of aneurysms treated by coil embolization is lower in smaller-sized aneurysms. However, with the WEB device, there is particular importance to sizing even for small-sized aneurysms. It is important to cover the complete neck and achieve aneurysm neck apposition because this sealing of the inflow results in elimination of the flow into the distal aspect of the aneurysm dome.
SPEAKER: This can result in quick stagnation. Thus, the WEB device does not have to accommodate the full size of the aneurysm, but rather may focus on just the neck, or the primary part of the aneurysm. The device opens, but in a suboptimal position low in the bifurcation. It is then recaptured and resheathed.
SPEAKER: The second attempt at deployment is much better, straddling the neck well in the AP view. In the postdeployment angiogram, note the contrast stasis along the posterior wall of the aneurysm. The seal at the neck of the aneurysm is much better now. The device is detached. The lateral view demonstrates the view of the WEB on WEB quite well.
SPEAKER: The contrast still hangs in the aneurysm several minutes later, as seen on this cone-beam CT in the sagittal direction. At 6-month angiographic follow- up, the aneurysm is occluded and only a small neck remnant remains. The patient continues to be clinically asymptomatic.
SPEAKER: Thank you.