case_images: PMC10927168_01
case_images: (a and f) Three-dimensional rotational angiography shows a giant right cavernous internal carotid artery aneurysm (27 x 26 mm). (b and g) A regular 0.017-inch microcatheter and 0.014-inch guidewire (arrow) can not be guided into the distal parent artery. (c and h) The neutral position of the Leonis Mova Selective (arrowheads). (d and i) By bending the tip of the Leonis Mova Selective toward the distal parent artery (arrows), the guidewire can be guided into the middle cerebral artery (e and j).
case_images: SNI-15-40-g001.jpg
case_images: PMC10927168_01_SNI-15-40-g001.jpg
case_images: F1
case_images: The aneurysm originated from the C4 portion of the right ICA, and the diameter of the dome was 27.6 x 25.1 mm [Figure 1a and f]. However, although the guidewire could be guided to the origin of the distal parent artery, it could not be guided further distally [Figure 1b and g]. Therefore, the Phenom 27 was exchanged for a Leonis Mova Selective, 150 cm [Figure 1c and h], and by bending the tip appropriately and keeping it directed toward the orifice of the distal parent artery [Figure 1d and i], the guidewire could be guided to the M2 portion of the middle cerebral artery [Figure 1e and j].
case_images: (a) When exchanging the Leonis Mova Selective for a 0.027-inch microcatheter using a 0.014-inch, 300-cm guidewire, the tip of the latter catheter (arrow) interferes with the orifice and cannot be advanced into the parent artery. (b) By introducing a 0.010-inch guidewire in parallel, the catheter can be guided to the distal parent artery. (c) Two flow diverters are implanted (arrowheads indicate the second stent).
case_images: SNI-15-40-g002.jpg
case_images: PMC10927168_01_SNI-15-40-g002.jpg
case_images: F2
case_images: During this procedure, the tip of the Phenom 27 was stuck at the orifice of the distal parent artery due to the "ledge effect" and could not be guided [Figure 2a]. A Chikai 10, 200 cm (Asahi Intecc) was inserted in parallel with the Chikai 14 to resolve the snagging, and the Phenom 27 was guided distally [Figure 2b]. A 4.5 x 35 mm Pipeline Embolization Device Flex with Shield Technology (Medtronic) was deployed from the C2 to C4 segment, and a similar 4.5 x 25 mm stent was overlapped along the neck [Figure 2c].