title: Transradial access or Simmons shaped 8F guide enables delivery of flow diverters in patients with large intracranial aneurysms and type III aortic arch: technical case report.
abstract: BACKGROUND
  Flow diversion with the pipeline embolization device (PED) is an emerging endovascular technology allowing curative embolization of very large and giant intracranial aneurysms. Many patients with these complex aneurysms are older. The presence of a tortuous type III aortic arch reduces the chances of successful PED delivery and increases the risk of complications. We report 2 technical nuances regarding the delivery of the PED in older patients with a complex aortic arch.
  
  
  METHODS
  In case 1, an 87-year-old woman presented with acute-onset left third nerve palsy. Workup demonstrated an 18-mm left posterior carotid wall aneurysm with a large daughter aneurysm on its dome. Endovascular access was complicated by a type III aortic arch with a hyperacute angle at the origin of the left common carotid artery. An 8F Simmons II shaped guide formed a stable platform, allowing successful PED delivery. In case 2, a 76-year-old woman experienced a transient ischemic attack. She harbored a right-sided 20-mm cavernous internal carotid artery aneurysm. She was treated with 2 PEDs deployed via a transradial approach.
  
  
  CONCLUSIONS
  Transradial access or guide support with the 8F Simmons II catheter grants stable access for curative embolization with the PED in elderly patients with a large intracranial aneurysm and a complex aortic arch.
authors.affiliation: Department of Neurosurgery, Sacred Heart Medical Center, Oregon Neuroscience Institute, Springfield, Oregon 97477-8800, USA.
authors.forename: Carolin
authors.initials: C
authors.lastname: Dietrich
authors.forename: Gesa H
authors.initials: GH
authors.lastname: Hauck
authors.forename: Luca
authors.initials: L
authors.lastname: Valvassori
authors.forename: Erik F
authors.initials: EF
authors.lastname: Hauck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery; D002406:Catheterization, Peripheral / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D011859:Radiography