Flow diverter assisted coil embolization of a very small ruptured ophthalmic artery aneurysm

Journal of Neurointerventional Surgery
David DornbosEric Sauvageau

Abstract

Small ruptured aneurysms present a unique problem to endovascular therapy. We report a case in which a patient presented with subarachnoid hemorrhage and a very small ruptured ophthalmic artery aneurysm, for which endovascular therapy was preferred secondary to severe cardiac comorbidities. Due to the aneurysm size, a small 1.5 mm coil was needed, but presented a significant risk of migration. Conventional stent assisted coiling was considered suboptimal as the small coil could have easily migrated through the strut. We present a novel technique of flow diverter assisted coil embolization in which a coil was placed within the aneurysm and a pipeline embolization device was then partially deployed, jailing the microcatheter and coil mass. Once in place, the coil was detached, securing the aneurysm, and preventing coil migration. Through the use of a flow diverter, some degree of aneurysm protection would still be expected in the event of coil migration toward the ophthalmic artery origin.

References

Nov 21, 2009·Stroke; a Journal of Cerebral Circulation·Waleed BrinjikjiDavid F Kallmes
Jul 27, 2010·Neurosurgery·Zsolt KulcsárDaniel Andre Rüfenacht
Oct 16, 2012·AJNR. American Journal of Neuroradiology·J P CruzT R Marotta
Nov 6, 2012·Clinical Neuroradiology·G K K LeungW M Lui
Nov 7, 2012·Journal of the American Heart Association·Nohra ChalouhiAaron S Dumont

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