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Endovascular Treatment of Distal Lenticulostriate Artery Aneurysm by Selective Catheterization of Artery with Balloon-Blocking Technique: 2-Dimensional Video Illustration
Journal Pre-proof Endovascular treatment of distal lenticulostriate artery aneurysm by selective catheterisation of artery with balloon blocking technique: 2-Dimensional Video Illustration Dr Anshu Mahajan, MD, DM (Neuroradiology), Dr Gaurav Goel, MD, DM (Neuroradiology) PII:
S1878-8750(20)30062-0
DOI:
https://doi.org/10.1016/j.wneu.2020.01.054
Reference:
WNEU 14084
To appear in:
World Neurosurgery
Received Date: 3 December 2019 Revised Date:
7 January 2020
Accepted Date: 8 January 2020
Please cite this article as: Mahajan A, Goel G, Endovascular treatment of distal lenticulostriate artery aneurysm by selective catheterisation of artery with balloon blocking technique: 2-Dimensional Video Illustration, World Neurosurgery (2020), doi: https://doi.org/10.1016/j.wneu.2020.01.054. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2020 Published by Elsevier Inc.
Full Title Endovascular treatment of distal lenticulostriate artery aneurysm by selective catheterisation of artery with balloon blocking technique: 2-Dimensional Video Illustration Short Title Balloon blocking technique for catheterisation of small lenticulostriate artery
Authors details: Mahajan A, Goel G 1. Co- Author: 1 – Dr. Anshu Mahajan, MD, DM (Neuroradiology) Consultant- Neurointervention surgery, Department of neurosciences. Medanta, The Medicity. Gurgaon, Haryana; India. [email protected] 2. Corresponding Author: 2- Dr Gaurav Goel, MD, DM (Neuroradiology) Associate director and Head-Neurointervention surgery, Department of neurosciences. Medanta, The Medicity. Gurgaon, Haryana; India. [email protected]
Conflict of Interest: None. Disclosure of Funding: None.
Manuscript We present a case of 15-yr-old male patient with polyarteritis nodosa who presented with ruptured lenticulostriate artery aneurysm and was successfully treated with endovascular Nbutyl-2-cyanoacrylate (n-BCA; Histoacryl, B. Braun, Melsungen, Germany) acrylic glue embolization. Selective catheterisation of lenticulostriate artery (LSA) is sometimes very difficult even with the low profile microcatheter (Magic 1.2 FM, Balt Extrusion, Montmorency, France) due to acute angulation at the origin of artery. In this 2-D video illustration of roadmap in digital subtraction angiography, reproduced after informed consent of the patient, we illustrate the balloon blocking technique to safely and effectively navigate microcatheter through the small perforator with difficult angulation at the origin. A Magic microcatheter was passed via a distal access catheter 070 (DAC; Concentric Medical, Mountain View, California) 105 cm in the internal carotid artery. The Magic microcatheter advancement was supported with a 0.008-inch guidewire (Hybrid 008, Balt Extrusion, Montmorency, France). Initial catheterisation of LSA even with low profile Magic microcatheter was difficult as origin of LSA was acute angled. While trying the navigate the microcatheter into the perforator, it was continuously flopping into the distal M1 segment of MCA (video 1). Balloon microcatheter was inflated just beyond the origin of LSA which provided support to the magic microcatheter and thus allowing its easy navigation into the LSA (video 2). Super selective injection confirmed filling of the lenticulostriate artery aneurysm. A dilute 33% concentration of the liquid embolic agent n-BCA mixed with Lipiodol (Guerbet, Aulnay-sous-Bois, France) was injected slowly under direct vision. Final check angiogram reveals complete occlusion of aneurysm.
DECLARATION OF COMPETING INTEREST
The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest
Highlights • Lenticulostriate artery aneurysm in patients with polyarteritis nodosa is rare. •
We report a rare case of lenticulostriate artery aneurysm in polyarteritis nodosa patient who was treated with endovascular treatment.
•
Selective catheterization of lenticulostriate artery with difficult angulation at origin can be done with balloon blocking technique.
Abbreviations N-butyl-2-cyanoacrylate (n-BCA) Lenticulostriate artery (LSA) Distal access catheter (DAC) Internal carotid artery (ICA) Middle cerebral artery (MCA)
S1878-8750(20)30062-0
DOI:
https://doi.org/10.1016/j.wneu.2020.01.054
Reference:
WNEU 14084
To appear in:
World Neurosurgery
Received Date: 3 December 2019 Revised Date:
7 January 2020
Accepted Date: 8 January 2020
Please cite this article as: Mahajan A, Goel G, Endovascular treatment of distal lenticulostriate artery aneurysm by selective catheterisation of artery with balloon blocking technique: 2-Dimensional Video Illustration, World Neurosurgery (2020), doi: https://doi.org/10.1016/j.wneu.2020.01.054. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2020 Published by Elsevier Inc.
Full Title Endovascular treatment of distal lenticulostriate artery aneurysm by selective catheterisation of artery with balloon blocking technique: 2-Dimensional Video Illustration Short Title Balloon blocking technique for catheterisation of small lenticulostriate artery
Authors details: Mahajan A, Goel G 1. Co- Author: 1 – Dr. Anshu Mahajan, MD, DM (Neuroradiology) Consultant- Neurointervention surgery, Department of neurosciences. Medanta, The Medicity. Gurgaon, Haryana; India. [email protected] 2. Corresponding Author: 2- Dr Gaurav Goel, MD, DM (Neuroradiology) Associate director and Head-Neurointervention surgery, Department of neurosciences. Medanta, The Medicity. Gurgaon, Haryana; India. [email protected]
Conflict of Interest: None. Disclosure of Funding: None.
Manuscript We present a case of 15-yr-old male patient with polyarteritis nodosa who presented with ruptured lenticulostriate artery aneurysm and was successfully treated with endovascular Nbutyl-2-cyanoacrylate (n-BCA; Histoacryl, B. Braun, Melsungen, Germany) acrylic glue embolization. Selective catheterisation of lenticulostriate artery (LSA) is sometimes very difficult even with the low profile microcatheter (Magic 1.2 FM, Balt Extrusion, Montmorency, France) due to acute angulation at the origin of artery. In this 2-D video illustration of roadmap in digital subtraction angiography, reproduced after informed consent of the patient, we illustrate the balloon blocking technique to safely and effectively navigate microcatheter through the small perforator with difficult angulation at the origin. A Magic microcatheter was passed via a distal access catheter 070 (DAC; Concentric Medical, Mountain View, California) 105 cm in the internal carotid artery. The Magic microcatheter advancement was supported with a 0.008-inch guidewire (Hybrid 008, Balt Extrusion, Montmorency, France). Initial catheterisation of LSA even with low profile Magic microcatheter was difficult as origin of LSA was acute angled. While trying the navigate the microcatheter into the perforator, it was continuously flopping into the distal M1 segment of MCA (video 1). Balloon microcatheter was inflated just beyond the origin of LSA which provided support to the magic microcatheter and thus allowing its easy navigation into the LSA (video 2). Super selective injection confirmed filling of the lenticulostriate artery aneurysm. A dilute 33% concentration of the liquid embolic agent n-BCA mixed with Lipiodol (Guerbet, Aulnay-sous-Bois, France) was injected slowly under direct vision. Final check angiogram reveals complete occlusion of aneurysm.
DECLARATION OF COMPETING INTEREST
The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest
Highlights • Lenticulostriate artery aneurysm in patients with polyarteritis nodosa is rare. •
We report a rare case of lenticulostriate artery aneurysm in polyarteritis nodosa patient who was treated with endovascular treatment.
•
Selective catheterization of lenticulostriate artery with difficult angulation at origin can be done with balloon blocking technique.
Abbreviations N-butyl-2-cyanoacrylate (n-BCA) Lenticulostriate artery (LSA) Distal access catheter (DAC) Internal carotid artery (ICA) Middle cerebral artery (MCA)