Abstract

Case Report

Direct Carotid Puncture for Flow Diverter Stent Insertion

Bhogal P*, Phillips TJ and Makalanda HLD

Published: 30 June, 2017 | Volume 1 - Issue 1 | Pages: 024-028

Objective: To report our experience of direct carotid puncture and its use in the management of a large and rapidly expanding cavernous aneurysm.

Methods: A patient with a cavernous aneurysm that measured 25mm in maximum diameter underwent treatment with flow diversion. The initial treatment strategy was parent vessel occlusion however she failed the balloon occlusion test at 3 minutes. Due to extremely tortuous vessels stable access via a common femoral artery approach was impossible to achieve. We present our strategy, the post-operative management and long term results.

Results: Using a direct carotid puncture three telescoped Pipeline embolisation devices were successfully deployed across the neck of the cavernous aneurysm without complication. The puncture site formed a stable platelet plug after direct compression with an ultrasound probe for 90 minutes with no post-operative complications either intracranially or at the neck puncture site. At 2 year follow-up the aneurysm is completely excluded from the circulation.

Conclusion: Direct carotid puncture can be used as access for intracranial interventional procedures even if patients are on dual anti-platelet medication.

Read Full Article HTML DOI: 10.29328/journal.jnnd.1001004 Cite this Article Read Full Article PDF

Keywords:

Aneurysm; Flow diverter; Stent; Carotid puncture

References

  1. Aletich VA, Debrun GM, Misra M, Charbel F, Ausman JI. The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago. J Neurosurg. 2000; 93: 388-396. Ref.: https://goo.gl/PuAqdw
  2. Blanc R, Piotin M, Mounayer C, Spelle L, Moret J. Direct cervical arterial access for intracranial endovascular treatment. Neuroradiology. 2006; 48: 925-929. Ref.: https://goo.gl/9k8njH
  3. Nii K, Kazekawa K, Onizuka M, Aikawa H, Tsutsumi M, et al. Direct Carotid Puncture for the Endovascular Treatment of Anterior Circulation Aneurysms. Am J Neuroradiol. 2006; 27: 1502-1504. Ref.: https://goo.gl/VMDZWU
  4. Guimaraens L, Theron J, Casasco A, Cuellar H. Carotid artery stenting by direct percutaneous puncture. J Vasc Surg. 2011; 54: 249-251. Ref.: https://goo.gl/XjMbct
  5. Perez-Arjona EA, Delprosto Z, Fessler RD. Direct percutaneous carotid artery stenting with distal protection: technical case report. Neurol Res. 2004; 26: 338-341. Ref.: https://goo.gl/NVRMSu
  6. Dorfer C, Standhardt H, Gruber A, Ferraz-Leite H, Knosp E, et al. Direct percutaneous puncture approach versus surgical cutdown technique for intracranial neuroendovascular procedures: technical aspects. World Neurosurg. 2012; 77: 192-200. Ref.: https://goo.gl/Mti6ai
  7. Takata H, Iida T, Akai T, Kumano K, Iizuka H, et al. Coil embolization for intracranial aneurysm by direct puncture of the carotid artery in elderly patients. Interv Neuroradiol. 1998; 4: 75-76. Ref.: https://goo.gl/1PHA57
  8. Yuzawa I, Kurata A, Suzuki S, Ozawa H, Hagiwara H, et al. Efficacy of a direct puncture approach for anterior circulation aneurysms using a newly developed guiding catheter - especially for geriatric patients. Surg Neurol. 2007; 67: 30-34. Ref.: https://goo.gl/fdjuoy
  9. Blanc R, Mounayer C, Piotin M, Sadik JC, Spelle L, et al. Hemostatic closure device after carotid puncture for stent and coil placement in an intracranial aneurysm: technical note. AJNR Am J Neuroradiol. 2002; 23: 978-981. Ref.: https://goo.gl/cfgSq2
  10. Modi S, Gadvi R, Babu S. Initial experience with AngiosealTM: Safety and efficacy of the endovascular closure device. Indian J Radiol Imaging. 2013; 23: 134-138. Ref.: https://goo.gl/aaaMVv
  11. Corley JA, Kasliwal MK, Tan LA, Lopes DK. Delayed Vascular Claudication Following Diagnostic Cerebral Angiography: A Rare Complication of the AngioSeal Arteriotomy Closure Device. J Cerebrovasc Endovasc Neurosurg. 2014; 16: 275-280. Ref.: https://goo.gl/nN5b8v
  12. Lewis-Carey MB, Kee ST. Complications of arterial closure devices. Tech Vasc Interv Radiol. 2003; 6: 103-106. Ref.: https://goo.gl/QSyVa6

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?