title: Techniques in distal access of wide-necked giant intracranial aneurysms during treatment with flow diversion.
abstract: BACKGROUND
  Accessing the normal distal vessel in treatment of wide-necked giant intracranial aneurysms with flow diversion can be difficult.
  
  
  METHODS
  Through illustrative cases, the authors present several useful techniques in distal access of wide-necked giant aneurysms during flow diversion treatment. Obtaining an optimal projection that separates the outflow limb from the aneurysm is most critical. Each of the three techniques described enabled the distal access to giant intracranial aneurysms during treatment with flow diversion.
  
  
  CONCLUSIONS
  The looped-around technique, balloon-assisted technique, and retrograde access are valuable strategies in crossing the aneurysm if direct distal access cannot be obtained.
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kan
authors.affiliation: Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Ajay Kumar
authors.initials: AK
authors.lastname: Wakhloo
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Maxim
authors.initials: M
authors.lastname: Mokin
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Ajit
authors.initials: A
authors.lastname: Puri
keywords: Distal access; flow diversion; giant intracranial aneurysms; neurovascular; wide-necked