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Pipeline Stent Placement for Embolization of Giant Cerebral Aneurysm

Supported by syngo DynaCT and syngo Neuro Aneurysm Analysis

Author: Michael J. Alexander, M.D.,
Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States

 

Patient history
Female patient presents with increasing retro-orbital pain and a right 6th nerve palsy.
 

Diagnosis
CTA scan demonstrated evidence of a giant right cavernous internal carotid artery aneurysm with a partial thrombosis and a smaller left carotid aneurysm. Treatment of the aneurysm using a Pipeline device was scheduled.

 

Treatment
After a DSA acquisition of the right common carotid a 3D DSA (5sDSA) was performed. The dataset get transferred and reconstructed at syngo Workplace automatically, and syngo Neuro Aneurysm Analysis was activated. After an automated segmentation of the target area, seed points were placed in the aneurysm as well as proximal and distal in the right internal carotid artery. syngo Neuro Aneurysm Analysis then calculated the size of the aneurysm, dome height and width and a centerline along the vessel. Based on this path a virtual stent was displayed. By adjusting its diameter and length the virtual stent was set to the actual vessel size and shape. The graphic was then overlaid onto live fluoro using syngo iPilot Dynamic/Enhanced. A microcatheter was advanced past the aneurysm into the right middle cerebral artery. Then, a Pipeline flow diverter device measuring 5 mm x 20 mm was delivered. Since there was still a contrast jet seen following placement of the first device, a second Pipeline stent measuring 5 mm x 16 mm was placed. A final 20 sec syngo DynaCT confirmed correct positioning of both devices. There was a marked decrease of contrast flow into the aneurysm and it was stagnant in later phases.

 

Comments
Fast and reliable planning of the deployment of the Pipeline devices was possible thanks to the seamless semi-automatic workflow in syngo Neuro Aneurysm Analysis (incl. Virtual Stent). Relevant measurements are displayed by default and overlaying the virtual stent graphic onto live fluoro is helpful to confirm the landing zone of the device. Using syngo iPilot is useful since it follows all C-arm and table movements during the procedure.

figure 1

DSA image demonstrating a giant aneurysm of the right internal carotid artery.

figure 2

3D DSA images from a 5sDSA acquisition are used for an evaluation with syngo Neuro Aneurysm Analysis (incl. Virtual Stent). The application helps to determine length and diameter of a stent device and gives the user helpful guidance when this image is overlaid onto the live fluoro image.

figure 3

A 20s DR syngo DynaCT confirmed nicely the correct position of the two Pipeline devices which were delivered to embolize the giant aneurysm.

Date: Jun 01, 2012


Angiography - Case Studies

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