Hirayama Akihiro, Srivatanakul Kittipong, Shigematsu Hideaki, Yokota Kazuma, Sorimachi Takatoshi, Matsumae Mitsunori
Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
J Neuroendovasc Ther. 2021;15(11):755-761. doi: 10.5797/jnet.tn.2020-0192. Epub 2021 Mar 9.
We report the utility of microcatheter reshaping by referring to fusion images with 3D-DSA and microcatheter 3D images made using non-subtraction and non-contrast (non-SC) rotational images.
Case 1: The patient was a 74-year-old man who had an internal carotid-anterior choroidal artery bifurcation aneurysm with a tortuous proximal parent artery. The initial attempt to introduce the microcatheter into the aneurysm was unsuccessful. During this unsuccessful microcatheter introduction, we created fusion images with 3D-DSA and microcatheter 3D images by acquiring positional information of the microcatheter using the non-SC method. By reshaping the microcatheter with reference to the fusion images, the direction of the distal end of the microcatheter was reshaped to be in accordance with the long axis of the aneurysm, a shape more suitable for coiling. Case 2: The patient was a 47-year-old man who had an anterior communicating (A-com) artery aneurysm with two daughter sacs. We successfully placed two microcatheters in the direction of each sac to make more stable framing by referring to 3D fusion images after the first microcatheter was positioned. In both cases, microcatheter reshaping was necessary because of the vessel and aneurysm anatomy. We have used this technique successfully in 15 patients, for both ruptured and unruptured aneurysms. The average number of microcatheter reshaping was 1.3 times.
This method provides effective microcatheter reshaping for coil embolization of aneurysms, particularly those with differences between the axis of the parent artery and the vertical axis of aneurysm, or with a tortuous proximal artery.
我们报告通过参考三维数字减影血管造影（3D-DSA）融合图像以及使用非减影和非对比（非SC）旋转图像制作的微导管三维图像来进行微导管重塑的效用。
病例1：患者为一名74岁男性，患有颈内动脉-脉络膜前动脉分叉处动脉瘤，其近端供血动脉迂曲。最初将微导管引入动脉瘤的尝试未成功。在这次不成功的微导管引入过程中，我们通过使用非SC方法获取微导管的位置信息，创建了3D-DSA融合图像和微导管三维图像。通过参考融合图像重塑微导管，微导管远端的方向被重塑为与动脉瘤的长轴一致，这是一种更适合进行栓塞的形状。病例2：患者为一名47岁男性，患有前交通（A-com）动脉动脉瘤，有两个子囊。在第一个微导管定位后，我们通过参考三维融合图像成功地将两个微导管分别放置在每个囊的方向，以实现更稳定的成篮。在这两个病例中，由于血管和动脉瘤的解剖结构，微导管重塑是必要的。我们已成功地将该技术应用于15例患者，包括破裂和未破裂的动脉瘤。微导管重塑的平均次数为1.3次。
该方法为动脉瘤的弹簧圈栓塞提供了有效的微导管重塑，特别是对于那些供血动脉轴与动脉瘤垂直轴存在差异或近端动脉迂曲的动脉瘤。
