Vacuum for straightening the microcatheter after intra-aneurysmal looping: The "Lagman vacuum" technique

Abstract

In many cases, an intra-arterial microcatheter loop is necessary to bypass the neck of wide-necked giant aneurysms for the placement of a stent across it. The removal of this loop is usually challenging, and many techniques have been described to achieve it. We describe a simple novel technique for straightening the microcatheter across the aneurysm's neck, without the need for additional products/devices or complex exchanging techniques. The method has been successfully applied in two cases. We named this novel maneuver the "Lagman vacuum" technique.

Keywords: Intracranial aneurysm; endovascular procedures; stents; therapeutic embolization.

Figure 1.

(a) To reach the distal vasculature an intrasaccular loop was necessary. (b) After withdrawal of the microwire and the application of our technique, the withdrawal of the small catheter results in the resolve of the loop. The tip of the microcatheter remains stable during the maneuver without the need of any additional material. (c) High resolution cone beam computed tomography (VasoCT, Philips Healthcare, Best, the Netherlands) shows the pathway of the stent within the aneurysm that follows the course of the microcatheter.

Figure 2.

(a) After creating a loop, the microcatheter navigated in a small M3-M4 branch of the right middle cerebral artery. The technique did not work when the microcatheter was in the larger angular artery. (b) The loop has been successfully resolved with the “Lagman vacuum” technique, with the microcatheter within the smaller branch. (c) A small contrast amount shows normal flow in the hosting branch.