RECOMMENDATION
- When you can navigate a 4Fr catheter into the bilateral external carotid arteries via a transradial approach, the subsequent embolization can be performed in the same manner.
- Never migrate NBCA into the arteries in the orbit.
- When you choose devices, avoid a one-size-fits-all decision.
Preparation
Angiography
Device
4Fr Fubuki guiding catheter
Defrictor nano
Defrictor zero DAC
CHIKAI x10*
25% NBCA**
*The CHIKAI 10 has a stiffer tip than the CHIKAI x10, providing higher selectivity but carrying a greater risk of perforation.It is suitable for navigating into side branches rather than tracking through tortuous arteries.
**The optimal concentration of NBCA remains unclear.
Procedure
Case Presentation
#1
Feeders: right middle meningeal artery, left middle meningeal artery, left anterior meningeal artery (- left anterior ethmoidal artery – left optic artery), right anterior cerebral artery.
Caution: The left anterior meningeal artery has dangerous anastomosis.
Operative Record
The DeFrictor Nano was navigated through the left MMA and superselectively advanced into the target feeding artery distal from the branch orifice of the AMA. The DeFrictor Nano was flushed with 5% glucose. The 25% NBCA was injected slowly. It was observed to penetrate the distal feeding artery and cast into the meningioma. The injection was closely monitored to prevent excessive proximal reflux or migration into the dangerous anastomosis via the AMA.
WILLPOWER MELTDOWN SOMETIMES 