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Case Reports
. 2011 Nov;69(5):1131-8.
doi: 10.1227/NEU.0b013e3182299814.

Use of the microangiographic fluoroscope for coiling of intracranial aneurysms

Mandy J Binning  1 , David Orion, Parham Yashar, Sharon Webb, Ciprian N Ionita, Amit Jain, Stephen Rudin, L Nelson Hopkins, Adnan H Siddiqui, Elad I Levy
Affiliations
Case Reports

Use of the microangiographic fluoroscope for coiling of intracranial aneurysms

Mandy J Binning et al. Neurosurgery. 2011 Nov.

Abstract

Background: Neurointervention is an ever-evolving specialty with tools including microcatheters, microwires, and coils that allow treatment of pathological conditions in increasingly smaller intracranial arteries, requiring increasing accuracy. As endovascular tools evolve, so too should the imaging.

Objective: To detail the use of microangiography performed with a novel fluoroscope during coiling of intracranial aneurysms in 2 separate patients and discuss the benefits and potential limitations of the technology.

Methods: The microangiographic fluoroscope (MAF) is an ultra high-resolution x-ray detector with superior resolution over a small field of view. The MAF can be incorporated into a standard angiographic C-arm system for use during endovascular procedures.

Results: The MAF was useful for improved visualization during endovascular coiling of 2 unruptured intracranial aneurysms, without adding significant time to the procedure. No significant residual aneurysm filling was identified post-coiling, and no complications occurred.

Conclusion: The MAF is a high-resolution detector developed for use in neurointerventional cases in which superior image quality over a small field of view is required. It has been used with success for coiling of 2 unruptured aneurysms at our institution. It shows promise as an important tool in improving the accuracy with which neurointerventionists can perform certain intracranial procedures.

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Figures

FIGURE 1
FIGURE 1
A, noncontrast computed tomography (CT) images reveal what appears to be a partially thrombosed aneurysm in the region of the right posterior communicating artery. B, CT angiography showing partially filling of the right posterior communicating artery aneurysm (circle).
FIGURE 2
FIGURE 2
Anteroposterior (A) and lateral (B) digital subtraction angiography images showing a 10 × 6-mm posterior communicating artery aneurysm. The pseudoaneurysm and dissection flap can be seen on the lateral view (arrow).
FIGURE 3
FIGURE 3
Image from a microangiographic fluoroscope (MAF) (anteroposterior projection). The tip of the microcatheter (arrow) can be seen easily. Before coiling, the MAF was used for placement of an Enterprise stent. The stent markers (arrowhead) are easily visualized.
FIGURE 4
FIGURE 4
Anteroposterior (A) and lateral (B) digital subtraction angiography images show no residual aneurysm filling and a widely patent stented internal carotid artery.
FIGURE 5
FIGURE 5
Anteroposterior (A) and lateral (B) pretreatment digital subtraction angiography images before coiling reveal a serpiginous and likely chronic dissection of the right middle cerebral artery (MCA). The right MCA ends in a blind pouch and curves around to give rise to the right anterior cerebral artery. The A1–A2 junction aneurysm can be seen on both projections (arrows). C, 3-dimensional angiography reveals a reasonably narrow neck for attempted primary coiling.
FIGURE 6
FIGURE 6
Fluoroscopic snapshot using a microangiographic fluoroscope shows individual coils and accurate catheter positioning with respect to the coil mass.
FIGURE 7
FIGURE 7
Anteroposterior (A) and lateral (B) posttreatment digital subtraction angiography (DSA) images acquired with the standard x-ray image intensifier demonstrate no residual filling of the aneurysm. Microangiographic fluoroscope (C) and image intensifier (D) images show comparison of the DSA runs between the 2 detectors.
See this image and copyright information in PMC

References

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