Morita Hiroya, Miyazaki Koichi
Department of Neurosurgery, Osaka Kaisei Hospital, Osaka, Osaka, Japan.
NMC Case Rep J. 2024 Nov 16;11:339-344. doi: 10.2176/jns-nmc.2024-0121. eCollection 2024.
In endovascular therapy, the induction and stable placement of the guiding catheter (GC) are not only the initial steps but also crucial techniques influencing treatment success. However, in some cases, GC induction is challenging due to variations in the aortic arch or tortuosity of the blood vessels. In the present case, endovascular therapy was carried out for a ruptured aneurysm in the dorsal portion of the left internal carotid artery. However, conventional GC could not be induced because of the type III aortic arch and extremely steep angle. By switching to an α-shaped GC, employed in conjunction with a distal access catheter, we were able to reach the aneurysm with a microcatheter and successfully complete the treatment. The tip of the α-shaped GC was positioned in the ascending aorta and thus required various considerations in terms of setup and device selection when compared to conventional techniques. This is the first report of the use of this catheter for the acute treatment of ruptured cerebral aneurysms. In this report, we share our experience and the effectiveness of using this catheter while highlighting our considerations.
在血管内治疗中，引导导管（GC）的导入和稳定放置不仅是初始步骤，也是影响治疗成功的关键技术。然而，在某些情况下，由于主动脉弓的变异或血管迂曲，GC导入具有挑战性。在本病例中，对左颈内动脉背侧破裂动脉瘤进行了血管内治疗。然而，由于III型主动脉弓和极其陡峭的角度，无法导入传统的GC。通过改用与远端接入导管联合使用的α形GC，我们能够用微导管到达动脉瘤并成功完成治疗。与传统技术相比。α形GC的尖端位于升主动脉内，因此在设置和设备选择方面需要各种考虑。这是关于使用该导管急性治疗破裂性脑动脉瘤的首次报告。在本报告中，我们分享使用该导管的经验和有效性，同时突出我们的考虑因素。
