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Case Sharing: Treatment of Intracranial Dissecting Aneurysms with FrebleTM Intermediate Catheter and Perfiller® Expansible Embolic Coil System

Case Sharing: Treatment of Intracranial Dissecting Aneurysms with FrebleTM Intermediate Catheter and Perfiller® Expansible Embolic Coil System

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Position:Intracranial Dissecting Aneurysm (IDA), V4 Segment Of The Vertebral Artery

Surgery: Stent-assisted aneurysm embolization.

Features: good passability, stable support performance, soft coil body

 

Patient Information

• Female, 55 years old.


Pre-operative imaging

• DSA Result: Preoperative angiography showed stenosis of the vertebral artery and an irregular aneurysm in the V4 segment of the vertebral artery.


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Procedure

• First, the surgeon placed the intermediate catheter "barely" into position, and the process was smooth. Under the stable support of the 6F TJWY FrebleTM intermediate catheter, they delivered the balloon in position and pre-dilated it. Then, with the assistance of the stent, they pushed the TJWY Perfiller® 2 mm×6 cm-3D expansible coil to form a basket.


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• After the basket was formed satisfactorily, doctors continued to fill the basket with Perfiller®1.5mm×3.0cm-3D, and finally close the basket with Perfiller®1.0mm×2.0cm-3D.


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After operation

• The postoperative angiography showed that the aneurysm was densely embolized, and no contrast agent was residual. The operation ended perfectly. The surgeon reported that the intermediate catheter has good passability and stable support performance; the expansible coil can be pushed smoothly and the coil body is soft.


• Interventional embolization treatment of intracranial aneurysm requires individualized surgical strategies. For IDA, due to the extremely tortuous, lengthened, and dilated arteries, it is difficult to place microcatheters and make accurate operations. It is a special type of aneurysm. The smooth and stable intracranial catheter is one of the key factors affecting the success of the operation.

 

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Intracranial dissecting aneurysm (IDA) refers to a pathological dissection between the intima and media, or between the media and adventitia of the intracranial artery, which leads to bulging of the arterial wall and aneurysmal dilated lesions[1-3]. IDA can occur in all ages, but it is more common in young people and middle-aged people, and is one of the important causes of stroke. IDA occurs more often in the vertebral artery, followed by the basilar artery and the internal carotid artery. The clinical manifestations of the disease are diverse and are closely related to the pathological damage pattern and lumina pattern of the diseased vessel wall[4].


With the development of nerve intervention, stent-assisted coil embolization has become an important method for endovascular treatment of IDA. In theory, it can not only occlude IDA, but also maintain the patency of the tumor-bearing artery. Many literature reports show that the stent-assisted coil embolization can be used to treat IDA, which has achieved good results; but this method still has the risk of postoperative bleeding and recurrence, and its efficacy still needs long-term clinical observation[5-6]. The principle of stent placement for the treatment of IDA is that the placement of the stent slows down or even changes the blood flow in the aneurysm cavity and promotes thrombosis in the aneurysm cavity. At the same time, the radial support force of the stent compresses the endocardial flap to attach it to the vessel wall, occludes IDA, promotes endothelial repair, and achieves anatomical healing[7].


Lepu Medical - TJWY Medical has launched two series (5F and 6F) of FrebleTM intermediate catheters recently. Among them, the 6F lumen diameter reaches 0.072", which is the largest lumen diameter among the intermediate catheters at present. A larger inner cavity diameter helps to further improve the compatibility of the device, and provides convenient conditions for subsequent dual-system or even multi-system operations.


FrebleTM intermediate catheters provide up to 18 specifications and models, providing a richer choice for clinics. Regardless of the 5F and 6F series, two shapes are available for tips, straight and pre-shaped at 25°, so that the surgeons can choose safer, more convenient and smoother shape when clinically facing tortuous blood vessels.


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TJWY Perfiller® polymer filament expansible coils include a complex type (3D) and a helical type (2D). The polymer filament swells when exposed to water, which can effectively increase the embolization density, and immediately achieve the effect of dense embolization. Moreover, the expansion of the polymer filament can effectively increase the stability of the coil body, avoid the overall compression of the coil caused by the impact of blood flow, thereby providing longer-lasting protection for the aneurysmal neck, avoiding "dog ear signs", and effectively reducing the long-term recurrence rate. 


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After the polymer filament expands with water, it is smaller than the first-level helical diameter of the coil. Its use process is not limited by time. It will not squeeze the adjacent coil and the wall of the aneurysm. It will only expand to the place with gaps. It will not over-expand that will cause the rupture of aneurysm.


The new push system makes the push rod transfer the force more accurately, and the push process is easier and smoother.


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To explore more about Lepu Neurointerventional solutions, please visit: https://en.lepumedical.com/products/neurointerventional-products/ 


References:

[1] Sikkema T, Uyttenbeogaart M, Eshghi 0,et a1. Intracranialartery dissection[J]. Eur J Neurol, 2014, 21(6): 820-826. DOI: 10. 1 11 I/ene. 12384.

[2] Mizutani T . Natural course of intracranialarterial dissections[J] . J Neurosurg, 2011, 114(4): 1037-1044. DOI: 10. 3171/2010. 9. JNSI0668.

[3] Ahn SS, Kim BM, SuhSH, et a1. Spontaneoussymptomatic intmcranial vertebrobasilar dissection: initialand follow—up imagingfindings[J]. Radiology, 2012,264(1): 196-202 . DOI: 10. 1148/radi01. 12112331.

[4] Mizutani T, Miki Y, KojimaH, et a1. Proposed classification of nonathemsclemtic cerebral fusiform and dissecting aneurysms [J]. Neurusurgery, 1999, 45(2) : 253-259; discussion 259-260.

[5] Neurosurgery Branch, Committee of Neurointervention Experts of the Chinese Medical Doctor Association, Neurointervention Branch of Chinese Stroke Society, Young Neurosurgeons Committee of the Chinese Medical Doctor Association The Chinese Expert Consensus on the Imaging Diagnosis of Intracranial Artery Dissection[J]. Chinese Journal of Neurosurgery, 2016, 32(11): 1085—1094. DOI: 10. 3760/ema.j. issn. 1001-2346. 2016. 11. 003.

[6] Zhang Y, Lv M, ZhaoC, et a1 . Endovascular treatmentof ruptured vertebrobasilar dissecting aneurysms: Reviewof 40 consecutive cases[J]. Neurol India, 2016, 64 Suppl: $5261. DOI: 10. 4103/1D028_3886. 178043.

[7] Wakhloo AK, Mandell J, GounisMJ, et a1. Stent—assisted reconstructive endovascular repair of cranial fusiform atheroscleroticand dissecting aneurysms : long—termclinical and angiographie follow-up[J] . Stroke200839(12) : 3288-3296 . DOI : 10 . 1161 / STROKEAHA. 107. 512996.

 

 

 

 





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