Stent Assisted Coiling of Right MCA AN

Published in October 27, 2023

Case Review

History

• 56 y/o male.

• 2019-4-17, the patient suffered from left limb weakness. MRI showed right corona radiata acute infarction and bilateral MCA aneurysms. Left MCA aneurysm embolization was performed in local hospital. Post-operation, the patient had headache, aphasia. CT demonstrated left temporal lobe hemorrhage. The symptoms largely recovered within a short period of time. The right MCA AN was scheduled for treatment in our hospital.

• NE: Partial motor aphasia.

Figure 1. CT scan demonstrates left MCA AN was embolized. Left watershed had malacia and chronic hemorrhagic foci.

Figure 2. MRI DWI sequence reveals no acute infarction.

Strategy

1. For such a wide necked MCA AN with a daughter sac, stent assisted coiling technique is spanferred.

2. Care should be taken to avoid daughter sac protrusion during microcatheter navigation.

Operation

Figure 3A. Headway 21 microcatheter was navigated into position.

Figure 3B. Headway 21 microcatheter was navigated into position.

Figure 4 GIF. Right MCA M1 segment was straightened.

Figure 5. AN Measurements.

Video 3. Headway-17 microcatheter with C curve was navigated into the aneurysm sac.

Figure 6 GIF. 1st coil Hypersoft 3mm*6cm.

Figure 7 GIF. Solitaire 4mm*20mm was placed for protecting superior branch of right MCA.

Figure 8 GIF. Hypersoft 2mm*4cm.

Figure 9 GIF. Hypersoft 2mm*4cm.

Figure 10 GIF. The coil (Hypersoft 2mm*4cm) punctured the aneurysm sac.

Figure 11 GIF. The bleeding was confirmed by angiography.

Figure 12 GIF. Released the tension of the coiling micro-catheter but failed to reinsert the loaded coil.

Comments

Log into post your comments