Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU

Embolization of Wide-neck MCA Embolization of Wide-neck MCA Bifurcation Aneurysm using Dual Bifurcation Aneurysm using Dual Microcatheter and Flow Diversion Microcatheter and Flow Diversion

TechniqueTechnique

Department of Neurosurgery, Changhai Hospital, SMMU

Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU

Case Report

• 55-year-Old Female

• Complaining of headache for 3 weeks

• Intracranial aneurysm incidentally found by MRI 2 weeks before admission.

• PE: Nothing significant

Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU

MR

Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU

CTA

• Acom aneurysm

• MCA bifurcation aneurysm, wide-neck, both trunks involved in the neck region

Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU

DSA

MCA bifurcation aneurysm wide-neck both trunks involved in the neck region

Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU

Dual Microcatheter tech.

• Partially embolized

Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU

Dual Microcatheter tech.

• Patency of both trunks was maintained

Superior trunk

Inferior trunk Inferior trunk

Superior trunk

Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU

Stent deployment

• Microcatheter advanced through the acute angle between M1 & superior trunck to M2 under the support of coils in the dome.

Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU

Stent deployment

• Rebar-18

• Solitaire 4/20

Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU

Post-embolization

• Raymond II

• Both trunks of MCA patent

Superior trunk

Inferior trunkInferior trunk

Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU

Flow diversion by stent

• Curvature between M1-M2 (superior trunk)

decreased in the same working projection

pre-embo. post-embo.

Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU

Follow up angio.

• 2-month-follow up angio.

Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU

CFD

Pre-stenting Post-stenting

Clinical Center of Neuroscience Clinical Center of Neuroscience Changhai Hospital, SMMUChanghai Hospital, SMMU

CFD

Pre-stenting Post-stenting