Coaxial Access for Microcatheter Stabilization During Aneurysm Coiling: 2-Dimensional Operative Video

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Coaxial support is crucial for neurointerventionalists to achieve optimal distal catheter control in intracranial circulation.
• Recurrent aneurysms, particularly after coiling, pose a significant risk of rebleeding, necessitating effective retreatment strategies.
• Tortuous internal carotid anatomy presents challenges for catheter manipulation during endovascular procedures.

Purpose of the Study:

• To demonstrate the utility of coaxial support in managing a recurrent anterior communicating artery aneurysm.
• To illustrate the application of coaxial support in stent-assisted coiling for complex aneurysm retreatment.
• To highlight the benefits of coaxial support in improving catheter control and reducing procedural risks.

Main Methods:

• A case presentation of a 41-year-old female with a recurrent anterior communicating artery aneurysm.
• The patient underwent stent-assisted coiling for retreatment, utilizing coaxial support advanced distally.
• Technique involved optimizing catheter control by reducing dead space, angulations, and vessel movement.

Main Results:

• Coaxial support facilitated precise microcatheter manipulation in a tortuous vascular anatomy.
• The technique provided a low-friction surface, enhancing maneuverability and reducing endothelial contact.
• Potential pitfalls like vasospasm were identified and managed with vasodilators.

Conclusions:

• Coaxial support offers a significant technical advantage for neurointerventionalists in complex retreatment scenarios.
• This technique is valuable for achieving optimal aneurysm occlusion, especially in cases with challenging anatomy.
• Careful patient selection and management of potential complications like vasospasm are essential for successful outcomes.