Neurol India Close
 

Figure 1: (a) A 50-year old male patient with subarachnoid hemorrhage and dissecting aneurysm of the right V4 segment vertebral artery. (b-d) The dual microcatheter technique: Two microcatheters are placed one at the distal part of the sac and the other at the proximal end of the sac. The first coil is deployed through the distally placed catheter. The coil is not detached and further coils are placed through the proximal catheter. The coil in the distally placed microcatheter is not detached until such time that a stable coil mass has been achieved through the proximal catheter. Also, the distally placed coil allows for packing of the distal end of the sac so that there is no retrograde filling of the aneurysm sac. (e) The parent artery is occluded. (f) Retrograde filling of the right vertebral artery distal to occlusion occurs along with some stasis; therefore, we prefer commencing on short term heparin course followed by antiplatelet agents. This technique is suitable for in patients with co-dominant or dominant contralateral vertebral artery and when the PICA or perforators are not arising from the aneurysm sac

Figure 1: (a) A 50-year old male patient with subarachnoid hemorrhage and dissecting aneurysm of the right V4 segment vertebral artery. (b-d) The dual microcatheter technique: Two microcatheters are placed one at the distal part of the sac and the other at the proximal end of the sac. The first coil is deployed through the distally placed catheter. The coil is not detached and further coils are placed through the proximal catheter. The coil in the distally placed microcatheter is not detached until such time that a stable coil mass has been achieved through the proximal catheter. Also, the distally placed coil allows for packing of the distal end of the sac so that there is no retrograde filling of the aneurysm sac. (e) The parent artery is occluded. (f) Retrograde filling of the right vertebral artery distal to occlusion occurs along with some stasis; therefore, we prefer commencing on short term heparin course followed by antiplatelet agents. This technique is suitable for in patients with co-dominant or dominant contralateral vertebral artery and when the PICA or perforators are not arising from the aneurysm sac