title: Efficacy of a direct puncture approach for anterior circulation aneurysms using a newly developed guiding catheter - especially for geriatric patients.
abstract: BACKGROUND
  Endovascular surgery is being increasingly used as an alternative to craniotomy clipping surgery, especially for aged patients and complicated cases. However, tortuous atherosclerotic arteries sometimes interfere with advancement of catheters so that direct puncture may be necessary. Short guiding catheters for use with this approach have been newly developed, as discussed in this article.
  
  
  METHODS
  One hundred twenty three anterior circulation aneurysms in 121 patients were consecutively treated by endovascular coil embolization, of which 42 (34%) were older than 70 years.
  
  
  RESULTS
  With 21 aneurysms, coil embolization via the transfemoral approach failed, but all could be successfully treated with the direct puncture approach with minor complications such as 1 transient ischemic attack and 1 nonsymptomatic minor leakage. In the aged patients, the direct puncture approach with short guiding catheter resulted in complete obliteration of aneurysms in 20 (71%) of 28 with follow-up angiography.
  
  
  CONCLUSIONS
  Direct puncture using newly developed short guiding catheters is an alternative to femoral approaches for patients with anterior circulation aneurysm with tortuous arteries and obvious atherosclerotic change at bifurcations of the common carotid artery.
authors.affiliation: Department of Neurosurgery, Kitasato University School of Medicine, 228-8555 Sagamihara, Japan. yuzawa@yk.rim.or.jp
authors.forename: Izumi
authors.initials: I
authors.lastname: Yuzawa
authors.forename: Akira
authors.initials: A
authors.lastname: Kurata
authors.forename: Sachio
authors.initials: S
authors.lastname: Suzuki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ozawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hagiwara
authors.forename: Jun
authors.initials: J
authors.lastname: Niki
authors.forename: Masaru
authors.initials: M
authors.lastname: Yamada
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Fujii
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kan
authors.forename: Takao
authors.initials: T
authors.lastname: Kitahara
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000628:therapy*; D017130:Angioplasty / Q000295:instrumentation*; D017536:Carotid Artery, Common; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008875:Middle Aged; D011677:Punctures / Q000295:instrumentation*; D012189:Retrospective Studies; D016896:Treatment Outcome