Multiple intracranial aneurysms (MIA) mean 2 or above aneurysms, which are common in clinical practice. Due to the increase in the number of aneurysms and diversity of their space distribution, MIA has been difficult in treating intracranial aneurysms. For MIA, a safe and effective therapeutic regimen should be provided according to the patient’s condition and the characteristics of aneurysms[1-2]. With the development of concepts and materials for interventional therapy, most aneurysms can be treated by endovascular embolization. The stent technology, balloon-assisted technology and double catheter technology also make wide-neck aneurysms no longer become the difficulties of interventional therapy[3]. For the treatment of MIA, endovascular intervention may also be preferred. It is not affected by the site of aneurysms, avoiding pull to the brain tissue; in addition, it features small incision, fast recovery and significant superiority[4-5]. When the lesion distribution space involves bilateral and even supratentorial/subtentorial encephalocoele, all the aneurysms cannot be treated with unilateral craniotomy once. In this case, embolization can be used to treat only the responsible aneurysm, and then the aneurysm can be treated by stages according to the risk of bleeding[6].
Patient Information
• Female, 70Y, hospitalized due to subarachnoid hemorrhage.
Surgery Plan
• To perform “aneurysm embolization with stent-assisted coil” in the surgery.
Pre-operative imaging
• Preoperative 3D DSA showed multiple intracranial aneurysms on the right side: Aneurysm (about 2.6mm*2.4mm in dimension) at the middle cerebral artery bifurcation and aneurysm (about 6.5mm*6.0mm in dimension) in the internal posterior communicating segment.
Procedure
• The aneurysm at the middle cerebral artery bifurcation on the right side was first treated. Guided by the approach graph during the operation, using the double microcatheter technique, put the stent microcatheter and embolic microcatheter in place, then select TJWY’s Perfiller® Expandable Coil System for Embolism 1.5mm*3cm-3D for basketing, liberate the stent half, fill one Perfiller® Expandable Coil System for Embolism 1.5mm*3cm-3D, finally close up with Perfiller® Expandable Coil System for Embolism 1mm*2cm-2D; after the dense embolization effect is reached, liberate the stent completely.
• The posterior communicating artery aneurysm (also responsible aneurysm) on the right side was then treated. Guided by the approach graph during the operation, using the double microcatheter technique, first put the stent microcatheter and embolic microcatheter in place, then select TJWY’s Perdenser® 7mm*30cm-3D for basketing, liberate the stent half, fill Perdenser® 5mm*15cm-2D, Perdenser® 4mm*10cm-3D and Perdenser® 3mm*8cm-2D, and Perdenser® 3mm*6cm-3D one after another, finally close up with Perdenser® 2mm*8m-2D; after the dense embolization effect is reached, liberate the stent completely.
• Liberating the second stent.
After Operation
• Perform radiography again to see that the two aneurysms were densely embolized, there was no contrast agent residue in the aneurysm cavity and the parent artery and branch vessel were clear.
Product Introduction
Lepu-Medical TJWY Perfiller® polymer expansible coils include a complex type (3D) and a helical type (2D). The polymer expansion 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 can effectively increase the stability of the coil, 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.
Since a certain gap is added between the metal wires of the expansible coil, the metal occupying effect of the expansible coil of the same length is lower, the coil body is softer than the bare coil, and the use process is safer and more effective.
After the polymer expands with water, it is smaller than the first-level 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.
References:
[1]Shangzhen Q, Lianting M, Jie G, et al. Treatment of intracranial multiple aneurysms［J］. Chinese Journal of Neurosurgery, 2012,28(9): 872-4.
[2]SibiliaJ, Gottenberg J E, Mariette X. Rituximab: a new therapeutic alternativein rheumatoid arthritis［J］. Joint Bone Spine, 2008, 75(5):526-32.
[3]CoiffierB, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared withCHOP alone in elderly patients with diffuse large- B- cell lymphoma［J］. N Engl J Med, 2002, 346(4):235-42.
[4]KishiJ, Nanki T, Watanabe K, et al. A case of rituximab- induced interstitialpneumonitis observed in systemic lupus erythematosus［J］. Rheumatology (Oxford), 2009, 48(4): 447-8.
[5]KawabataY,Nakazawa T, Fukuda S. Endovascular embolization of branch-incorporatedcerebralaneurysms[J]. Neuroradiol J, 2017, 30(6):600-606.
[6]YangY, Su W, Meng Q. Endovascular treatmentof ruptured true posteriorcommunicating artery aneurysms[J]. Turk Neurosurg,2015, 25(1):73-77.
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