Coil embolization of renal artery aneurysms: Simultaneous delivery of three microdevices with a novel 6-Fr guiding sheath

Abstract

Here, we report the case of a 59-year-old male patient who underwent transcatheter embolization of bilateral renal artery aneurysms, using 2 microballoons and 1 microcatheter, all carried within a single guiding sheath. During coil embolization in a visceral artery, there are situations that can require multiple microdevices. We developed a new 6-Fr Shephard-hook type guiding sheath (Parent Plus 60) with a lumen large enough to deliver three microdevices simultaneously. This technique can be used broadly in different clinical scenarios, and it may provide novel treatment strategies to clinicians in the future.

Keywords: Coil embolization; Guiding sheath; Microballoon; Microcatheter; Renal artery aneurysm.

Fig. 1

(a) Two microballoon catheters (Scepter C, MicroVention Terumo, Tustin, CA) and one microcatheter (Excelsior SL-10, Stryker, Kalamazoo, MI, USA) are deliverable from Parent Plus 60. (b) Total of three insertion valves were prepared by connecting a Y-type connector to the lateral hole of another, enabling the simultaneous manipulation of three microdevices.

Fig. 2

(a) An abdominal contrast enhanced computed tomography (CT) demonstrates bilateral renal artery aneurysms (arrow). (b) 3D CT angiography shows the right renal artery aneurysm located at the bifurcation of the main renal artery (arrow) and consisted of two branches (arrowhead). (c) The left renal artery aneurysm was also found at the bifurcation of main renal artery (arrow) and consisted of two branches (arrowhead).

Fig. 3

(a) An angiography from the right renal artery showing the aneurysm with 2 outflow branches. (b) Two microballoons (Scepter C, arrow), and one microcatheter (Excelsior SL-10) are delivered from the Parent Plus 60. Contrast medium was injected through the lateral hole of the proximal Y-type connecter, showing the microballoons and the microcatheter are at the adequate position to start coiling. (c) Coil packing was performed under double microballoon assistance. (d) Angiography after embolization of the aneurysm demonstrates preserved circulation to the branches of the aneurysm.

Fig. 4

(a) An angiography from the left renal artery shows the aneurysm located at the bifurcation of the main renal artery. (b) Two microballoons (Scepter C, arrow), and 1 microcatheter (Excelsior SL-10) are delivered from the Parent Plus 60. (c) Fluoroscopic image demonstrating the inflated Scepter C balloons with delivery of the initial detachable coil within aneurysm sac. (d) Angiography after completion of the procedure demonstrating complete obliteration of the aneurysm sac with preservation of flow into the distal branches and renal parenchyma.