Tigertriever 13 Stentectomy

  • Female patient (1955), SAH in June 2020 recovered from GCS 3 to GCS 15, no deficit

  • Coiling of ACM aneurysm, microaneurysm on lentriculostriatal artery observation

  • Control DSA at 3 months, showed recurrence at the neck of ruptured aneurysm, and treatment with recoiling and stent placement was planned

  • Coiling of the neck was performed. To increase good result, placement of atlas through m2 into m1 was done, patient was on DAPT for 5 days beforehand and levels of aggregation were satisfactory.

  • Closing of distal part of atlas was noticed, as well as occlusion of parietal branch from neck of the aneurysm.

  • Bolus dosage of IA integrilin was applied as well as an increase in IV aspirin.

  • During wait, thrombosis was increasing, so PTA with scepter XC was performed to ensure proper apposition on vessel wall, but during the waiting period again thrombosis was noticed.

  • Not wanting to risk occlusion of whole branch, stentectomy with tiger 13 was performed.

  • Atlas was crossed with headway duo through which tiger 13 was opened at distal portion and beyond

  • Tiger 13 was slowly released while pinching proximal part with microcath.

  • When it was noticed that tiger caught atlas, advancement of navien 072 was made into m1, as well as ballast guide almost to ophthalmic segment.

  • Then, navien with tiger and atlas were pulled into ballast

  • Control run, as well as dyna CT, were made to ensure there was no bleeding

  • Occlusion of the branch at the neck was still present but on lateral images, due to cortical leptomeningeal anastomosis filling was retrograde.

  • Patient was awakened, with minor hand paresis which resolved next day.

Dr. Vladimir Kalousek, KBC Sestre Milosrdnice, Croatia


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