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Published on: August 11, 2015
Transcirculation retrograde placement of a Pipeline embolization device for treatment of a vertebrobasilar junction
Visish M Srinivasan1, Christopher S Graffeo1, Lea Scherschinski1
1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Insights
Transcirculation catheterization, a retrograde approach, successfully treated a complex vertebrobasilar junction aneurysm. This endovascular technique enabled Pipeline embolization device placement when antegrade access was impossible.
Area of Science:
- Neurosurgery
- Endovascular Therapy
- Cerebrovascular Surgery
Background:
- Transcirculation catheterization, or retrograde approach, navigates endovascular devices between arterial circulations.
- Complex vertebrobasilar junction aneurysms pose treatment challenges, especially after prior interventions preclude standard antegrade access.
Purpose of the Study:
- To present a case of complex vertebrobasilar junction aneurysm treatment using transcirculation catheterization.
- To demonstrate the feasibility of Pipeline embolization device (PED) placement via a retrograde approach when antegrade access is not possible.
Main Methods:
- A patient with a complex vertebrobasilar junction aneurysm, previously treated with bilateral vertebral artery deconstruction, was selected.
- An occipital artery to posterior inferior cerebellar artery (PICA) bypass was created for protection.
- Transcirculation catheterization was performed via a transradial approach, accessing the right internal carotid artery.
- A microwire-microcatheter navigated through the right posterior communicating artery to the basilar trunk and left PICA.
- A Pipeline embolization device (PED) was deployed from the left vertebral artery to the mid-basilar artery.
Main Results:
- The Pipeline embolization device (PED) was successfully deployed using the transcirculation technique.
- The vertebrobasilar junction aneurysm was completely obliterated at 3-month follow-up.
- The retrograde approach provided a viable alternative for endovascular treatment in challenging anatomies.
Conclusions:
- Transcirculation catheterization is an effective retrograde endovascular technique for treating complex cerebrovascular lesions.
- This approach is particularly valuable for aneurysms where standard antegrade access is compromised.
- Flow diversion using PED via transcirculation offers a successful treatment option for vertebrobasilar junction aneurysms.
Abstract:
Transcirculation catheterization, also known as the retrograde approach, involves the navigation of a catheter or other endovascular device from one arterial circulation to the other (right to left, or anterior to posterior).1-4 We present a case of a complex vertebrobasilar junction aneurysm previously treated by bilateral vertebral artery deconstruction, precluding antegrade access (video 1). Following the creation of a protective occipital artery to posterior inferior cerebellar artery (PICA) bypass, the patient was treated with transcirculation placement of a Pipeline embolization device (PED).5-9 The right internal carotid artery was accessed with a guide catheter using a transradial approach. The microwire-microcatheter combination was then tracked through the right posterior communicating artery, down the basilar trunk, and to the left PICA. The PED was successfully deployed from the left vertebral artery to the mid-basilar artery. At 3-month follow-up, the aneurysm was completely obliterated. The nuances of transcirculation technique, especially for flow diversion, are discussed. (Used with permission from Barrow Neurological Institute, Phoenix, Arizona, USA.) neurintsurg;17/9/1024/V1F1V1Video 1Transcirculation retrograde placement of a Pipeline embolization device for treatment of a vertebrobasilar junction aneurysm previously treated by bilateral vertebral artery deconstruction, precluding antegrade access.
