Introducing Technical Concepts of Looping Techniques in Endovascular Neurosurgery to Budding Surgeons in Cases of Intracerebral Aneurysms

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BSTRACT

Endovascular neurosurgery is a branch of catheters and guidewires and understanding how they behave and function in vivo with laws of physics is utmost important for a successful vascular intervention. This technical report aims to throw light on the techniques learnt during the training programme in our institute in the scope of endovascular neurointervention with the objective to make endovascular catheter and wire handling more easy for the upcoming generations to follow and make the field of Endovascular Neurosurgery a safer territory. The guidewire (Terumo 0.035”) used in the guiding catheters is an excellent wire made up of nitinol alloy with a hydrophilic M-coating and polyurethane plus tungsten cover. The 1st technique is ‘External looping technique’ of the guidewire, which helps in tracking the guidewire into the presumed direction without the need to shift the guiding catheter face. This is based on the principle of One-piece construct with one-to-one torque transmission. The 2nd technique describes the technique of Anterior cerebral artery (ACA) cannulation in patients with small calibre ACA using a microguidewire loop and rotating the construct in the internal carotid artery (ICA) trunk while withdrawing. The 3rd technique explains the technique of microcatheter loop inside the giant aneurysms for tracking into the distal vessel for Flow diverter or stent-assisted coiling techniques, which is based on the principle of inherent straightening tendency of the microcatheter.