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CASE REPORT
The bumper technique for advancing a large profile microcatheter
  1. Christopher P Kellner,
  2. Alexander G Chartrain,
  3. Claire Schwegel,
  4. Thomas J Oxley,
  5. Hazem Shoirah,
  6. J Mocco
  1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
  1. Correspondence to Dr C P Kellner, 1450 Madison Avenue, Klingenstein Clinical Center, 1-North, New York, NY 10029, USA; christopher.kellner{at}mountsinai.org

Abstract

Operators commonly encounter difficulty maneuvering a microcatheter beyond the distal lip of wide neck aneurysms and aneurysms in challenging locations. Few techniques have been described to guide operators in these particular situations. In this case report of a 56-year-old woman with a 16 mm ophthalmic artery aneurysm, the microcatheter continually snagged the distal aneurysm lip, preventing delivery of a flow diverter into the distal parent vessel. In troubleshooting this obstacle, a second microguidewire was introduced alongside the microcatheter and was used to cover the distal lip of the aneurysm to prevent further snagging. The second guidewire successfully deflected the microcatheter into the distal vessel, a technique that we have aptly dubbed the ‘bumper technique’.

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Footnotes

  • Republished with permission from BMJ Case Reports Published 1 March 2017; doi:10.1136/bcr-2016-012872

  • Twitter Follow Christopher Kellner @chriskellnerMD

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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