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Micro-WADA and balloon test occlusion for sacrifice of distal P2 aneurysm
  1. Sameer Saleem Tebha1,
  2. Robert Underwood2,
  3. Vishwanath Sagi3,
  4. Dale Ding1,
  5. Robert M Starke4,
  6. Isaac Josh Abecassis1
    1. 1Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
    2. 2Department of Neuropsychology, University of Louisville, Louisville, Kentucky, USA
    3. 3Department of Neurology, University of Louisville, Louisville, Kentucky, USA
    4. 4Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
    1. Correspondence to Isaac Josh Abecassis; Isaac.Abecassis{at}uoflhealth.org

    Abstract

    Here we present a fusiform, partially thrombosed, previously ruptured aneurysm in the posterior cerebral artery that was treated with parent vessel sacrifice after a micro-WADA and micro-balloon test occlusion (video 1). These aneurysms pose treatment challenges due to their deep location, morphology, and potentially eloquent distal supply.1 2 Primary coiling, stent assisted coiling, or microsurgical clipping are often not viable options, whereas flow diversion, parent vessel sacrifice,3 or trapping with bypass are usually employed. Pharmacological provocative testing via a micro-WADA4 ,5 with or without a micro-balloon test occlusion is critical to establish whether the territory at risk has functional eloquence, although specific reports for using these techniques are limited. We describe the patient presentation, initial treatment attempt and failure, and our protocol for performing a micro-WADA/balloon test occlusion test.

    Video 1  Micro wada for PCA aneurysm.

    • Balloon
    • Aneurysm
    • Catheter
    • Coil
    • Flow Diverter

    https://doi.org/10.1136/jnis-2024-022058

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      Footnotes

      • X @Starke_neurosurgery, @@drjoshabecassis

      • Contributors SST drafted the first draft. IJA, RMS, RU, DD, and VS collectively reviewed and edited the manuscript and made substantial changes. IJA, RU, and VS were involved with the treatment and follow-up of the patients. All authors approved the manuscript for publication.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

      • Competing interests IJA: consultant for Balt, Rapid Medical, Imperative Care, IschemaView, Von Medical, and Remedy Robotics; equity in Hyperion, Von Medical, and Remedy Robotics; and grant funding from CNS Foundation. RMS: research supported by NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, and National Institutes of Health (R01NS111119-01A1 and UL1TR002736, KL2TR002737) through the Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH; unrestricted research grant, consulting, and teaching agreement with Medtronic; consulting and teaching agreement with Penumbra, Abbott, InNeuroCo, and Cerenovus.

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