ABSTRACT
Acute iatrogenic occlusion of cerebral vessels is a risk during the performance of neuroendovascular procedures. Most commonly this is a result of thrombus formation within the vessel, thromboembolism or an acute vasospastic response. There are several options for flow restoration including pharmacological, mechanical and microsurgical. Mechanical flow restoration, usually by thrombectomy, is typically performed in large cerebral vessels. Current mechanical thrombectomy devices have limited utility in smaller vessels that are more difficult to access, such as the anterior cerebral artery (ACA). We present two cases where successful flow restoration of an intraoperative acutely occluded or thrombotic ACA was rapidly achieved by balloon dilation using a new coaxial dual-lumen balloon catheter. The time elapsed from the decision to use the balloon catheter until revascularization for each patient was 5 min and 46 s (case 1) and 10 min and 25 s (case 2).
Subject(s)
Angioplasty, Balloon/instrumentation , Anterior Cerebral Artery/surgery , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases/surgery , Cerebral Revascularization/methods , Aneurysm, Ruptured/surgery , Angiography, Digital Subtraction , Angioplasty, Balloon/methods , Catheters , Cerebral Angiography , Cerebrovascular Circulation , Female , Humans , Iatrogenic Disease , Magnetic Resonance Angiography , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Stents , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/surgery , Thrombectomy , Thromboembolism/etiology , Thromboembolism/therapy , Treatment Outcome , Vasospasm, Intracranial/etiologyABSTRACT
Acute iatrogenic occlusion of cerebral vessels is a risk during the performance of neuroendovascular procedures. Most commonly this is a result of thrombus formation within the vessel, thromboembolism or an acute vasospastic response. There are several options for flow restoration including pharmacological, mechanical and microsurgical. Mechanical flow restoration, usually by thrombectomy, is typically performed in large cerebral vessels. Current mechanical thrombectomy devices have limited utility in smaller vessels that are more difficult to access, such as the anterior cerebral artery (ACA). We present two cases where successful flow restoration of an intraoperative acutely occluded or thrombotic ACA was rapidly achieved by balloon dilation using a new coaxial dual-lumen balloon catheter. The time elapsed from the decision to use the balloon catheter until revascularization for each patient was 5 min and 46 s (case 1) and 10 min and 25 s (case 2).
