A novel technique is reported that helps the operator in achieving reliable access to the distal parent vessel with a microcatheter for stent assisted aneurysm coiling. Distal parent vessel access was obtained by allowing the microwire to follow the local hemodynamics into a giant internal carotid artery aneurysm and around its dome. Various traditional methods were tried before attempting the balloon anchor. In this technique, an over-the-wire balloon was inflated in the distal vessel followed by gentle retraction of the balloon catheter and microwire allowed only a wire bridge across the aneurysm neck, thereby allowing the stent catheter to be brought up in a standard fashion. This technique may facilitate the use of new stent technologies for the treatment of aneurysms that would otherwise be untreatable with endovascular therapies.
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Competing interests LNH receives research support from Toshiba; serves as a consultant to Abbott, Boston Scientific, Cordis, Micrus and WL Gore; has a financial interest in AccessClosure, Boston Scientific, Cordis and Micrus; serves as a board member, trustee or holds an officer position in AccessClosure and Micrus; receives honoraria from Bard, Boston Scientific and Cordis; has a financial interest in Valor Medical; and also receives royalties from Cordis (for the AngioGuard device). EIL receives research grant support (principal investigator: Stent-Assisted Recanalization in acute Ischemic Stroke, SARIS), other research support (devices) and honoraria from Boston Scientific and research support from Micrus Endovascular and ev3; has ownership interests in Intratech Medical Ltd and Mynx/Access Closure; serves as a consultant on the board of Scientific Advisors to Codman Neurovascular/Cordis Corporation; serves as a consultant per project and/or per hour for Micrus Endovascular, ev3 and TheraSyn Sensors, Inc; and receives fees for carotid stent training from Abbott Vascular and ev3. EIL receives no consulting salary arrangements. All consulting is per project and/or per hour. JM is a consultant for Actelion Inc; and his employer (University of Florida at Gainesville) receives educational funding and consultant reimbursement from Codman. SKN is the recipient of the 2010–2011 Cushing Award of the Congress of Neurological Surgeons. AHS has received research grants from the University at Buffalo and from the National Institutes of Health (NINDS 1R01NS064592-01A1, Hemodynamic induction of pathologic remodeling leading to intracranial aneurysms); is a consultant to Codman Neurovascular/Cordis Corporation, Concentric Medical, ev3 and Micrus Endovascular; serves on speakers' bureaus for Codman Neurovascular/Cordis Corporation and Genentech; and has received honoraria from Genentech, Neocure Group LLC, American Association of Neurological Surgeons' courses and an Emergency Medicine Conference and from Codman Neurovascular/Cordis Corporation for training other neurointerventionists. AHS receives no consulting salary arrangements. All consulting is per project and/or per hour.
Patient consent Detail has been removed from this case description to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Provenance and peer review Not commissioned; externally peer reviewed.