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Initial Experience of a Novel Sheath Guide for Transbrachial Coil Embolization of Cerebral Aneurysms in the Anterior Cerebral Circulation

Iwata, Tomonori MD; Mori, Takahisa MD, PhD; Tajiri, Hiroyuki MD; Miyazaki, Yuichi MD; Nakazaki, Masahito MD; Mizokami, Koji MD

doi: 10.1227/NEU.0b013e31826e2cd9
Instrumentation and Technique

BACKGROUND: The transfemoral approach is a common technique for coil embolization of cerebral aneurysms in the anterior cerebral circulation. However, it is difficult to advance a guiding catheter into the carotid artery via the femoral route in patients with a tortuous aortic arch, an unfavorable supra-aortic takeoff, aortic diseases, or occlusion of the femoral artery.

OBJECTIVE: To report our initial experiences of coil embolization of cerebral aneurysms in the anterior cerebral circulation with a novel sheath guide for transbrachial carotid cannulation.

METHODS: A sheath guide designed specifically for transbrachial carotid cannulation was developed; transbrachial coil embolization for cerebral aneurysms began in May 2011. Included for analysis were patients who underwent transbrachial coil embolization for cerebral aneurysms in the anterior cerebral circulation from May 2011 to January 2012. Adjuvant techniques, angiographic results, procedural success, and periprocedural complications were investigated.

RESULTS: Ten patients underwent transbrachial coil embolization of cerebral aneurysms in the anterior cerebral circulation. All procedures were successful using the brachial route. No periprocedural complications occurred. Patients were permitted to get seated immediately after coil embolization even during hemostasis.

CONCLUSION: The sheath guide specifically designed for transbrachial carotid cannulation was useful for coil embolization of cerebral aneurysms in the anterior cerebral circulation.

ABBREVIATIONS: CAS, carotid artery stenting

ICA, internal carotid artery

Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center, Kanagawa, Japan

Correspondence: Takahisa Mori, MD, PhD, Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center, Okamoto 1370-1, Kamakura City, Kanagawa 247-8533, Japan. E-mail: morit-koc@umin.net

Received February 14, 2012

Accepted July 24, 2012

Copyright © by the Congress of Neurological Surgeons