The gently pull-back technique for neck bypass in treatment of wide-necked internal carotid artery aneurysms: A report of three cases and review of the literature.
Neck bypass failure in endovascular treatment of wide-necked internal carotid artery (ICA) aneurysms may adversely affect the technical success of the procedure. We used the gently pull-back technique to bypass the aneurysm neck and access the distal parent artery during endovascular treatment in patients with wide-necked ICA aneurysms. In this technique, a loop was made in the aneurysm and the distal parent artery was reached by using a small diameter microguidewire and a microcatheter. After providing reliable distal access, the microguidewire was removed and the whole system which consists of the microcatheter was gently pulled back. Finally the microcatheter was straightened and the aneurysm neck was passed. After crossing the aneurysm neck, a flow-diverting stent treatment and stent-assisted coiling were performed in three cases with wide-necked ICA aneurysm. The gently pull-back technique is a simple and effective method which requires no extra intravascular device and helps to bypass the aneurysm neck through a small diameter microguidewire and a microcatheter. This technique may be useful for neck aneurysm bypass in endovascular treatment of wide-necked ICA aneurysms.
Department of Radiology, Afyon Kocatepe University, Turkey dremrekacar0258@hotmail.com.
Emre
E
Kacar
Department of Radiology, Uludag University, Turkey.
Omer F
OF
Nas
Department of Radiology, Uludag University, Turkey.
Ahmet
A
Kaya
Department of Radiology, Uludag University, Turkey.
Cuneyt
C
Erdogan
Department of Neurosurgery, Uludag University, Turkey.
Hasan
H
Kocaeli
Department of Radiology, Afyon Kocatepe University, Turkey.
Bahattin
B
Hakyemez
D000368:Aged; D002340:Carotid Artery Diseases / Q000473:pathology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002404:Catheterization; D002533:Cerebral Angiography; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D015607:Stents
Wide-necked aneurysm; bypass technique; endovascular