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Down-The-Barrel Working Projection for Coiling Selected Bifurcation Aneurysms in A Single-Plane Angiosuite
Madan Mohan Balaguruswamy1, Sampathkumar Palanisamy1, Ezaz Mohamed2
1Department of Neurointerventional Radiology, Royal Care Super Specialty Hospital, Neelambur, Coimbatore, Tamil Nadu, India.
Neurology India
|November 10, 2022
Summary
A novel "down-the-barrel" projection technique aids in coiling ruptured anterior communicating artery aneurysms when conventional views fail. This 3D rotational angiography strategy enhances neuroendovascular procedures in single-plane systems.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Cerebrovascular Imaging
Background:
- Conventional angiography projections for aneurysm coiling typically use 2D imaging.
- Obtaining optimal views can be challenging for complex aneurysms, such as those in the anterior communicating artery.
Observation:
- Two cases of ruptured anterior communicating artery aneurysms presented difficulties with conventional working projections in a single-plane angiography system.
- A "down-the-barrel" working projection was successfully employed by aligning the origins of the A2 segments of bilateral anterior cerebral arteries.
Findings:
- A translucent volume-rendered image from 3D rotational angiography was used to create the "down-the-barrel" view.
- This technique enabled the successful completion of the coiling procedure for both ruptured aneurysms.
Implications:
- The "down-the-barrel" projection offers a viable alternative when conventional methods are insufficient for aneurysm coiling.
- This strategy can enhance neuroendovascular procedures in single-plane angiosuites, improving treatment options for complex cerebrovascular cases.
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