Intracranial Carotid Artery Aneurysm Treatment: First Reported Case of DERIVO®Flow-Diverter Placement by Direct Carotid Artery Puncture.

Giuseppe Guzzardi,Bruno Del Sette,Andrea Paladini,Carmelo Stanca,Massimiliano Cernigliaro,Andrea Galbiati,Alessandro Carriero,Marco Spinetta,Massimiliano Leigheb

doi:10.3390/brainsci10050320

Abstract

Brain health may be threatened by aneurysm ruptures, and early recognition of these vascular malformations allows for neuroradiological intervention. Neurointerventional procedures are usually performed with femoral artery access. In patients with severe anatomical complexity of the supra-aortic vessels, however, treatment by this approach could be hindered or impossible. Flow-diverter stent deployment is an effective and safe treatment for large, wide necked intracranial aneurysms, but it requires a complete and firm stability of the coaxial system to achieve a correct and precise deployment of the device. We present the first reported Italian case of a patient with an intracranial aneurysm which was treated with Flow-diverter stent (DERIVO®; AcandisGmbH & Co. KG; Pforzheim; Germany) by direct common carotid artery puncture due to severe tortuosity of supra-aortic trunks.

Highlights

Endovascular treatment of intracranial aneurysms is becoming widely available and nowadays has become the first choice of treatment in many centers, especially for older patients with high surgical risks [1,2,3]
We present the first reported Italian case of a DERIVO Flow Diverter stent (FDS) placement in wide necked intracranial aneurysm by direct carotid puncture
Figure sheath placed in the common carotidcarotid artery after direct vessel puncture

Summary

Introduction

Endovascular treatment of intracranial aneurysms is becoming widely available and nowadays has become the first choice of treatment in many centers, especially for older patients with high surgical risks [1,2,3] This approach usually has shorter procedural times and is commonly associated with shorter recovery and hospitalization times compared to the traditional neurosurgical approach [4]. This shift towards endovascular procedures has been increasing since the introduction of new generation flow diverter stents (FDS) to the market, which allow for the treatment of wide necked aneurysms [5]. The possibility of using different vascular access rather than the classic femoral artery, such as the radial or carotid ones, could help reduce this failure rate

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Discussion

Conclusion