2017 年 11 巻 5 号 p. 266-271
Objective: A tip shape of a microguidewire that is safe and highly versatile in coil embolization of cerebral aneurysms was evaluated.
Case Presentations: Case 1: A 65-year-old woman with subarachnoid hemorrhage due to rupture of an anterior communicating artery aneurysm which was coil-embolized 7 years before. The aneurysm recanalized and regrew thereafter, and an additional embolization was performed. Angiography before treatment showed 50% stenosis at the origin of the right internal carotid artery (ICA). In addition, the A1 of the right anterior cerebral artery divided from the ICA at a relatively sharp angle. Therefore, the tip of the microguidewire was shaped to a modified pigtail. With this single tip shape, the wire and microcatheter could be safely guided to the anterior communicating artery aneurysm, and satisfactory coil embolization could be achieved. Case 2: A 68-year-old woman with right hemiplegia had a sudden onset of occlusion of the M2 superior trunk of the left middle cerebral artery and underwent thrombectomy. A microguidewire with a tip shaped into a modified pigtail could cross the lesion safely through the occluded segment with no distal view of the course of the vessel. The thrombus was retrieved using a stent retriever, and thrombolysis in cerebral infarction (TICI) 3 could be achieved.
Conclusion: This microguidewire tip shaping technique is considered to be safe and effective in various phases of endovascular treatment.