1Ehab Mahmoud,1Chrsitoffer Nyberg, 1Chrsitoffer Nyberg, 1Borota Ljubisa

1Uppsala University Hospital ( Akademiska)

Background(s):

A good working view is critical for safe and successful endovascular treatment of cerebral aneurysms. In a few cases, endovascular treatment of cerebral aneurysms may be challenging because of difficulty in obtaining a proper working view.  In this report of 6 cases, we described the advantage of using a distal intracranial catheter (DIC) to achieve better visualization of cerebral aneurysms hidden by a parent artery and/or its branches.

Material(s) and Method(s):

Between September 2017 and January 2021, we treated 390 aneurysms with endovascular techniques. In six cases in which it was difficult to obtain a proper working view, the DIC was placed distally close to the aneurysm in order to remove the parent artery projection from the working view and obtain better visualization of the aneurysm. Clinical, procedural outcomes and complications were evaluated.

Result(s):

The position of the DIC was above the internal carotid artery (ICA) siphon in the six cases.  All aneurysms were successfully embolized. Raymond–Roy class 1 occlusion was achieved in all four unruptured aneurysms, while the result was class 2 in the two ruptured aneurysms. Placement of the DIC was atraumatic without dissections or significant catheter-induced vasospasm in all patients. Transient dysphasia was seen in two cases and transient aphasia in one.

Conclusion(s):

Using this technique, we have found it possible to better visualize the aneurysm sac and/or neck and thereby treat cases we otherwise would have consider untreatable.