65-year-old male with hypertension and history of myocardial infarction and coronary stenting with incidental left internal carotid artery aneurysm.
The patient had a wide-necked aneurysm of the supraclinoid portion of the internal carotid artery. The patient was on antiplatelet medication due to the coronary stent increasing the risk of surgery, and the wide-neck of the aneurysm made simple coiling a poor option.
The patient was brought to the angiography suite and placed under general anesthesia and neurological monitoring. We proceeded to catheterize the left internal carotid artery with a Neuron guide catheter and with a Berenstein Select catheter. Once the guide catheter was in position in the left ICA, the patient was heparinized to an activating clotted time of 250 or greater for the remainder of the procedure. The left middle cerebral artery was catheterized with the Hi-Flo Neuro Renegade system, and a Neuroform EZ 4.5 x 30 mm stent was deployed across the widenecked aneurysm from left M1 segment to left internal carotid artery just beyond the ophthalmic artery takeoff. Subsequently, the deployed stent was recrossed, and a second stent, Neuroform EZ 4.5 x 20 mm, was placed across the aneurysm.
Following stent placement, syngo DynaCT was performed to verify 3-dimensional conformation of stents across the aneurysm. An SL-10 microcatheter and a Synchro microguidewire were used to gain access to the aneurysm, before the aneurysm was coiled with Matrix coils.
The excellent detail resolution of syngo DynaCT helped to check the correct deployment of the Neuroform EZ stent and to further analyze the aneurysm architecture before coiling.
MIP thin (10 mm) slices
Images obtained with parallel and radial ranges
Figure 1: AP digital subtraction angiography of wide-necked left internal carotid artery aneurysm.
Figure 2: Lateral DSA of left ICA aneurysm.
Figure 3: Advancement of microcatheter through first stent for deployment of second stent. The radio-opaque tines shows demonstrate the limits of the first stent (stored roadmap sequence).
Figure 4: Slices through the aneurysm after stent placement using syngo DynaCT.
Figure 5: Rotation about the axis of the Neuroform EZ stents using syngo DynaCT, demonstrating the architecture of the aneurysm and the exact placement of the stents prior to coiling.
Figure 6: Final AP angiography showing occlusion of the aneurysm.