Microsnare-assisted microcatheter navigation for flow diversion of a challenging giant intracerebral aneurysm: a...

Giant cerebral aneurysms are associated with a poor prognosis, with 2-year survival rates reported as low as 20% (Sundt et al.; Syman et al.). Morbidity is largely associated with haemorrhage, local compressive effects and thrombosis. While endovascular coiling has been acknowledged as a safe treatment in small to medium size aneurysms (Molyneux et al.; Pierot, Spelle & Vitry), the safety of this technique is more questionable in giant aneurysms due to the unknown stability of the coiling mesh and the need for retreatment. Parent vessel remodelling with the use of flow diverters is an evolving technique with promising results (Pierot et al.). However, navigation of microcatheters within the parent artery across giant aneurysms may be challenging due to tortuous anatomy. To improve microcatheter trackability and stability across a giant aneurysm neck, we describe a novel microsnare-assisted support technique.