Abstract

Endovascular navigation past some large or giant intracranial aneurysms for the purpose of stent deployment can be difficult. Some of these lesions have a morphology which compels the operator to navigate through the aneurysm dome in order to gain distal access, a step which requires straightening of the delivery microcatheter before a stent can be deployed. In most patients this can be achieved by simply retracting the microcatheter and reducing the loop within the aneurysm. However, in certain patients the acute angle formed between aneurysm inflow and outflow tracts as well as the dynamics of tension within the microcatheter act together to prevent this from happening. Instead of retracting and straightening across the aneurysm neck, the microcatheter withdraws leaving the intra-aneurysm loop intact. This challenge can thwart attempts at stent placement and subsequent embolization. The authors describe a simple and safe technique to circumvent this problem, a way of stabilizing the distal tip of the microcatheter which they term the ‘sea anchor’.