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Transradial Access or Simmons Shaped 8F Guide Enables Delivery of Flow Diverters in Patients With Large Intracranial Aneurysms and Type III Aortic Arch: Technical Case Report

Dietrich, Carolin*; Hauck, Gesa H.*; Valvassori, Luca MD; Hauck, Erik F. MD, PhD*

doi: 10.1227/NEU.0b013e31827e0d67
Technical Case Report

BACKGROUND AND IMPORTANCE: Flow diversion with the pipeline embolization device (PED) is an emerging endovascular technology allowing curative embolization of very large and giant intracranial aneurysms. Many patients with these complex aneurysms are older. The presence of a tortuous type III aortic arch reduces the chances of successful PED delivery and increases the risk of complications. We report 2 technical nuances regarding the delivery of the PED in older patients with a complex aortic arch.

CLINICAL PRESENTATION: In case 1, an 87-year-old woman presented with acute-onset left third nerve palsy. Workup demonstrated an 18-mm left posterior carotid wall aneurysm with a large daughter aneurysm on its dome. Endovascular access was complicated by a type III aortic arch with a hyperacute angle at the origin of the left common carotid artery. An 8F Simmons II shaped guide formed a stable platform, allowing successful PED delivery. In case 2, a 76-year-old woman experienced a transient ischemic attack. She harbored a right-sided 20-mm cavernous internal carotid artery aneurysm. She was treated with 2 PEDs deployed via a transradial approach.

CONCLUSION: Transradial access or guide support with the 8F Simmons II catheter grants stable access for curative embolization with the PED in elderly patients with a large intracranial aneurysm and a complex aortic arch.

ABBREVIATIONS: ICA, internal carotid artery

PED, Pipeline Embolization Device

*Department of Neurosurgery, Sacred Heart Medical Center, Oregon Neuroscience Institute, Springfield, Oregon

Department of Neurosciences, Niguarda Ca’ Granda Hospital, Milan, Italy

Correspondence: Erik F. Hauck, MD, PhD, Sacred Heart Medical Center, Oregon Neuroscience Institute, 3333 Riverbend Dr, Springfield, OR 97477-8800. E-mail:

Received March 13, 2012

Accepted August 29, 2012

Copyright © by the Congress of Neurological Surgeons