Exchange technique using flow directed microcatheter during difficulty in navigation of delivery catheter in stent-assisted coil embolization

Abstract

Objectives: We report a modified technique for delivery of Prowler Select Plus (PSP) in stent-assisted coil embolization for wide neck aneurysms using Enterprise VRD.
Case presentation: Delivery of PSP was impossible by the standard method due to acute angulation and complex anatomy at the neck in two cases (basilar artery aneurysm and the left middle cerebral artery aneurysm). The flow directed catheter, Marathon 1.5F was navigated into the aneurysm, turned along the aneurysmal wall, and send to the target vessel dependent on the flow. Tension of the turn in the aneurysm was decreased using a micro-guidewire, CHIKAI 0.010” 300 cm. Then CHIKAI was further advanced to distal portion of the target vessel as much as possible. Marathon was exchanged to PSP and the procedure was completed thereafter with successful closure of the aneurysm.
Conclusion: This technique appears useful in case the delivery of PSP is difficult though several tips and pitfalls were noted.