Name:
10.3171/2022.7.FOCVID2262
Description:
10.3171/2022.7.FOCVID2262
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/9499c9b5-8863-48f2-8102-f2877cd1d2ab/videoscrubberimages/Scrubber_223.jpg
Duration:
T00H04M28S
Embed URL:
https://stream.cadmore.media/player/9499c9b5-8863-48f2-8102-f2877cd1d2ab
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/9499c9b5-8863-48f2-8102-f2877cd1d2ab/4. 22-62.mp4?sv=2019-02-02&sr=c&sig=tg3s%2F%2FUavVJHivSO%2FDbT2JQn%2BcU84%2FSNZzyv0fBZHYE%3D&st=2024-05-05T20%3A58%3A39Z&se=2024-05-05T23%3A03%3A39Z&sp=r
Upload Date:
2022-09-14T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
[MUSIC PLAYING]
SPEAKER: This is the case of FRED flow diversion with LVIS protection of a large posterior communicating artery aneurysm--the FRELVIS technique--in an elderly woman who was found down at home and transported to the ED, where she was found to have a Hunt and Hess 3, Fisher 4 subarachnoid hemorrhage on noninvasive imaging. An irregularly shaped right PCA aneurysm was observed, and it was subsequently coil embolized. Follow-up angiography demonstrated a recurrent neck, and the decision was made to pursue additional treatment.
SPEAKER: Here is the initial CT showing the Fisher 4 subarachnoid hemorrhage, as well as the CTA reconstructions demonstrating the aneurysm. Here are 3D DSA images showing the initial aneurysm prior to first coil embolization. Here are follow-up DSA images showing the recurrent neck of the aneurysm following coil compaction. Radial access was obtained, and the Armadillo guide catheter was brought up over the 0.035 GLIDEWIRE into the right common carotid artery.
SPEAKER: This is demonstrated here. At this point, you can see the Armadillo guide catheter preparing to make the bend into the common carotid artery. We are able to advance the Armadillo guide catheter into the internal carotid artery.
SPEAKER: At this point, a Synchro SELECT microwire was used to access the right posterior communicating artery in preparation for placement of the LVIS stent across the orifice. Here you can see this is a fetal- type posterior communicating artery. The artery is relatively large in diameter, and therefore supplying significant flow to the ipsilateral posterior cerebral artery.
SPEAKER: Once our microcatheter is in place, we place a second microcatheter into the aneurysm and place a coil partially in to help lock that catheter into place.
SPEAKER: The LVIS Jr. 2.5 × 23–mm stent is then brought up into the posterior communicating artery and deployed. This is used to ensure integrity of the orifice of the posterior communicating artery. We then made a quick attempt at using a Comaneci device to coil the aneurysm. However, this was not possible secondary to the largest Comaneci device available not being large enough to cover the aneurysmal orifice.
SPEAKER: And therefore, a 4.5 × 20–mm FRED flow diverter was placed across the orifice of the aneurysm as well as the posterior communicating artery through the internal carotid artery. Here is our final run demonstrating stasis of contrast within the aneurysm as well as the final construct. The patient tolerated the procedure well and was discharged home on postoperative day 1 at her neurological baseline.
SPEAKER: At approximately 3 months postprocedure, an MRA was obtained which shows delayed but continued filling of the aneurysm. Here you can see multiple images demonstrating this. This Is not unexpected with flow diversion. The patient will continue to be followed closely for possible recurrence and/or resolution.