Case 1 - Multiple Irregular Aneurysms
Patient Information
Female, 57 years old.
CC: Sudden headache, vomiting, limb weakness for more than 4 hours, progressive disturbance of consciousness for more than 2 hours.
Present medical history: Head CT showed subarachnoid hemorrhage. Head and neck CTA increased scans suggested multiple intracranial aneurysms.
Initial diagnosis: Aneurysm at the bifurcation of the left internal carotid artery, irregular aneurysm in the posterior communicating segment of the left internal carotid artery, and large aneurysm in the ocular segment of the right internal carotid artery.
Aneurysm measurement
-A saccular aneurysm of 7.5×5.2mm can be seen at the bifurcation of the ICA.
-An irregular aneurysm in the P-com segment of ICA is 3.4×6.9mm - 4.6×7mm.
Access establishment
-After adjusting to the working position angle, use a Synchro-14 (0.014” ×200 cm) micro-guidewire to carry the Prowler Select Plus micro-catheter to the MCA under the guidance of the road map.
-The guide wire guides the SL-10 microcatheter to the lumen of the aneurysm in ICA bifurcation.
Coil embolization (bifurcation of ICA)
-Numen™ MicroFill 7mm×20 cm was filled through SL-10 microcatheter.
-Using Semi-jailing technique to press Enterprise2 stent against the neck of the aneurysm, and continue to fill the Numen™ MicroFill 4.0mm×15cm through the SL-10 microcatheter.
Access establishment (P-com)
Withdraw the microcatheter to exit the aneurysm of the bifurcation, and use the micro guidewire to guide the microcatheter into the irregular aneurysm of the P-com segment.
Post-procedure
Working position and lateral angiography showed that the aneurysm was completely packed and the parent artery was unobstructed.
Preoperative Angiography
Physician Feedback
In this case, there are multiple aneurysms on the left side with irregular aneurysms and multiple daughter-sacs, so the coil must be selected with high flexibility and good compliance to achieve dense packing.
NumenTM coil is very flexible and has low force against aneurysm wall.
In addition, the NumenTM coil has so strong space seeking ability that can be used to fill irregular aneurysms.
Due to the irregular shape and rupture of aneurysms, there is an even greater need for coil with superior performance. NumenTM coil’s performance is so good that can compete with the world’s best coils.
In summary, NumenTM coil can satisfy the embolization of various complex aneurysms.
—— Dr. Xie Xiaodong
Female, 80 years old.
Present medical history: Head CT showed subarachnoid hemorrhage. Suffering from hypertension and hyperlipidemia.
Diagnosis:
Hunt-Hess I, MRS level 1
An irregular aneurysm in right P-com artery
Aneurysm D-max: 5.19mm
Aneurysm neck: 2.85mm
Aneurysm body/neck: 1.82
Case 2 - Irregular Aneurysm in P-com
Patient Information
Coil used:
Numen MicroFinish 4.0mm×8cm, 2mm×6cm, 1.5mm×3cm
Numen MicroFill 2mm×6cm, 2mm×6cm
Post-procedure Follow up
Post-procedure DSA shows 43% Packing density
For irregular aneurysms with daughter sac, the choice of coil is very important, especially the first coil: it should have very small force of the aneurysm wall stable basket and should have good space seeking ability.
-The doctor chose MicroFinish as first coil, its Ω+S configuration have both stable framing ability and flexibility.
-MicroFinish and MicroFill 2mm×6cm are single suture design, it improves even more Numen’s softness.
-Numen has exceptional space seeking ability to ensure dense packing.