PMC6306058_01
Head DSA images showing left internal carotid artery aneurysm in the supraclinoid segment.. Notes: (A) Head CT angiography image; (B) computer-assisted reconstructions of head CT angiography image.. Abbreviations: CT, computer tomography; DSA, digital subtraction angiography.
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The aneurysm was irregular in shape and appeared leaf-lobulated with a size of 5.2x3.7 mm2 (Figure 1).
Head DSA images showing the insertion of Target 360 ULTRA coil (5 mm x 15 cm) into the cavity of the aneurysm.. Note: (A-C) are views of the location of the coil at different angles and proximity.. Abbreviation: DSA, digital subtraction angiography.
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Then, a Target 360 ULTRA coil (5 mm x 15 cm; Stryker Corporation, Fremont, CA, USA) was delivered into the aneurysm cavity via the Echelon-10 microcatheter, and the basket-forming of the coil was good (Figure 2).
Head DSA images showing delivery of a Solitaire AB stent to the distal bifurcation of the left internal carotid artery.. Note: (A-C) are views of the location of the stent at different angles and proximity.. Abbreviation: DSA, digital subtraction angiography.
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A Solitaire AB stent (6 x 20 mm; ev3 Neurovascular) was delivered to the distal bifurcation of the left ICA through the Rebar-27 microcatheter (Figure 3).
Head DSA images showing acute in-stent thrombosis and treatment with arterial thrombolysis.. Notes: (A, B) are views of the half-released Solitaire stent at different angles and proximity. (C) Disappearance of anterior communicating artery. (D) Injection of 10 mg tirofiban through microcatheter trying to dissolve the thrombus.. Abbreviation: DSA, digital subtraction angiography.
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The stent was released half open to partially block the opening of the aneurysm in the supra-clinoid segment of the left ICA (Figure 4A and B). Axium (2 mm x 2 cm) coil were delivered into the aneurysm cavity via Echelon-10 microcatheter. Angiography showed a complete embolization of the aneurysm, but the anterior communicating artery was not developed (Figure 4C). As a result, 10 mL tirofiban was injected through the microcatheter (Figure 4D), and the Helix ev3 Axium (2 mm x 2 cm) coil was withdrawn, but the left ICA was poorly developed (Figure 5A and B).
Head DSA images showing occlusion of the left internal carotid artery.. Notes: (A, B) are views of the disappearance of the left internal carotid artery from different angles. (C) Retraction of MicroPlex 10 HyperSoft Helical coil.. Abbreviation: DSA, digital subtraction angiography.
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Axium (2 mm x 2 cm) coil were delivered into the aneurysm cavity via Echelon-10 microcatheter. Angiography showed a complete embolization of the aneurysm, but the anterior communicating artery was not developed (Figure 4C). As a result, 10 mL tirofiban was injected through the microcatheter (Figure 4D), and the Helix ev3 Axium (2 mm x 2 cm) coil was withdrawn, but the left ICA was poorly developed (Figure 5A and B). So the Solitaire AB stent was retracted, during which the MicroPlex 10 HyperSoft Helical coil was removed from the lumen of the aneurysm (Figure 5C).
Head DSA images showing no aneurysm development, and the left internal carotid artery was recanalized.. Note: (A-D) are views of the left internal carotid artery at different angles and proximity.. Abbreviation: DSA, digital subtraction angiography.
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Repeat DSA showed no aneurysm development, and the left ICA was unobstructed (Figure 6A-D).
Head DSA images showing the left internal carotid artery was occluded distal to the ophthalmic segment, and no collateral circulation was found.. Notes: (A) LICA angiography. (B) RICA angiography. (C) LVA angiography.. Abbreviations: DSA, digital subtraction angiography; LICA, left internal carotid artery; LVA, left vertebral artery; RICA, right internal carotid artery.
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The left ICA was found to be occluded distal to the ophthalmic segment, and there was no collateral circulation from either the anterior communicating artery or the posterior communicating artery (Figure 7).
Head DSA images showing Echelon-10 microcatheter was delivered to the left middle cerebral artery M1 segment and 100,000 units of urokinase was given through the Echelon-10 microcatheter.. Notes: (A) RICA angiography showing the occlusion site. (B) Delivery of Echelon-10 microcatheter. Injection of 100,000 units of urokinase through the Echelon-10 microcatheter to dissolve the thrombus.. Abbreviations: DSA, digital subtraction angiography; RICA, right internal carotid artery.
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About 100,000 units of urokinase was given through the Echelon-10 microcatheter but failed to dissolve the thrombus (Figure 8).
Head DSA images showing after two rounds of stent thrombectomy, the left internal carotid artery was completely recanalized.. Notes: (A) Angiography image showing the left internal carotid artery was partially recanalized after the first round of stent thrombectomy. (B) Angiography image showing the left internal carotid artery was completely recanalized after the second round of stent thrombectomy. (C) Thrombi removed by stent thrombectomy.. Abbreviation: DSA, digital subtraction angiography.
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AB stent (4 x 20 mm) was also delivered to the left MCA M1 segment beyond the thrombus formation site; then, the Rebar-18 microcatheter was retracted, the Solitaire AB stent was open fully and also retracted to remove the thrombus. After two rounds of stent thrombectomy, the left ICA was completely re-canalized (Figure 9).