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Case report
Flow-directed micro-catheterisation technique over a detachable coil
  1. Henrik Ullman,
  2. Jesse Jones,
  3. Naoki Kaneko and
  4. Satoshi Tateshima
  1. Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
  1. Correspondence to Dr Henrik Ullman, ullman{at}ucla.edu

Abstract

Embolisation of neonatal arteriovenous shunts poses several challenges: tortuous and fragile vessels, limited contrast volume and few specialised paediatric endovascular devices. In a 9-day-old patient with a choroidal type vein of Galen malformation we encountered an extremely tortuous posterior choroidal artery pedicle during endovascular treatment. After attempted selection using a traditional over-the-wire technique, we advanced a platinum coil through the micro-catheter. High flow within the feeder directed the soft and malleable coil anterograde. We then advanced the catheter over the coil’s pusher wire in a facile manner to an ideal position for embolisation. This approach may be especially useful in cases requiring coil/vinyl-based liquid embolics, given that the only flow-directed micro-catheter available to most operators is compatible with n-Butyl cyanoacrylate alone. Moreover, the soft distal portion of coil may impart a safety benefit over traditional guidewires in easily perforated neonatal vasculature.

  • neuroimaging
  • radiology
  • interventional radiology
  • congenital disorders
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Footnotes

  • Contributors HU wrote manuscript, JJ edited manuscript, NK gave feedback to manuscript and ST gave feedback to manuscript, primary operator during procedure.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Parental/guardian consent obtained.

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