Down-The-Barrel Working Projection for Coiling Selected Bifurcation Aneurysms in A Single-Plane Angiosuite

Conventionally, the working projection for aneurysm coiling demonstrates the inflow artery, the aneurysm dome, the neck, and bifurcation branches in a two-dimensional (2D) image. We report two cases of ruptured Anterior communicating artery aneurysms, in whom a conventional working projection could not be obtained in a single plane angiography system. We used a down-the-barrel working projection created by aligning the origins of the A2 segments of bilateral anterior cerebral arteries to complete the coiling procedure. The translucent volume-rendered image obtained using three-dimensional rotational angiography was utilized to create a Down-the-barrel view. This strategy may be employed by operators performing neuroendovascular procedures in single plane angiosuites when a conventional working projection strategy fails.