Tri-axial access systems for endovascular embolization of cerebral aneurysms of the anterior circulation in the acute rupture period

Abstract

Objective – to evaluate the advantages of tri-axial systems with the possibility of «distal access» with endovascular embolization of cerebral aneurysms of the anterior circulation in the acute period of rupture.
Materials and methods. In the course of consecutive 15 operations, endovascular embolization of cerebral aneurysms in the acute rupture period, a triaxial access system was used. The system included a «long» introducer (IVA LONG IVA 6F80, Balt), a distal access catheter (Fargo 6F 115 cm in 8 cases, FargoMax 6F 115 cm in 2 cases and Sofia 6F 115 cm in 1 case) or a guiding catheter (Chaperon 6F in 4 cases) and a microcatheter (Vasco+ 10D or Headway 17) with a microguidewire (Hybrid 1214, Traxcess 14, Avigo, Agility 14). To identify intraoperative complications, angiography data were analyzed and the diameter of the arteries before and after the intervention was measured. Evaluation of angiographic data was performed in standard, and if necessary, additional projections. The diameter of the vessels (A1-A2-segments of the Anterior Cerebral Artery (ACA), М1-М2-segments of the Medial Cerebral Artery (MCA), petrosium and cavernous segment of the Internal Cerebral Artery (ICA) was measured in the anterior–posterior plane. Immediately after the operation, all patients underwent control computed tomography.
Results. In all cases, there were no pronounced difficulties in navigating and catheterizing the cavity of the aneurysm, there was no need to reconfigure the tip of the microcatheters or change the microguidewire. The microcatheter did not lose its «controllability» even against the background of the pronounced tortuosity of the brachiocephalic arteries or iliac segments. By the end of the operation, in no case was an increase in angiospasm noted. In all observations, a regression of the severity of spasm was noted, with the absence of the latter in 12 cases. In none of the cases were there intraoperative thromboembolic or hemorrhagic complications.
Conclusions. Tri-axial access provides good proximal support and reduces the risk of developing intraoperative complications during endovascular embolization of aneurysms of the anterior circulation in the acute period of rupture. When accessing the aneurysms of the anterior cerebral anterior communicating artery complex, the routine use of distal access catheters is justified.