Case Presentation - Aristotle 14 Guidewire

The following case was provided by Jeremy Heit, MD, PhD, Clinical Assistant Professor, Department of Radiology and Neurosurgery, Stanford University Hospital.

Aristotle 14 Guidewire was utilized in the treatment of a Cognard Type IV Dural Arteriovenous Fistula (DAVF)

Case Presentation:  A young patient presented with headaches and was incidentally found to have a Cognard Type IV DAVF.  The DAVF was located in the tentorium and was supplied by tentorial arteries arising from the left meningophypophyseal trunk (MHT), which itself is a branch of the internal carotid artery.  The venous drainage of the DAVF was into an irregular cortical vein with an associated venous aneurysm.  The patient underwent trans-arterial embolization of the DAVF.  The internal carotid artery was selected with a 6F shuttle sheath and a 6F distal access catheter was positioned in the cavernous internal carotid artery proximal to the meningohypophyseal artery origin.  Attempts were made to select the MHT with a Synchro 14 microwave and a Headway Duo microcatheter.  The origin of the MHT was selected with a Synchro microwire, but the wire and microcatheter could not be navigated into the MHT without prolapse into the ICA.  The Synchro microwave was removed, and the MHT was easily selected with the Aristotle microwave on the first attempt.  The Aristotle microwave was navigated more distally within the MHT, which allowed the Headway Duo microcatheter to be navigated to the origin of the tentorial artery arcade that supplied the DAVF.  A blocking balloon microcatheter was positioned across the MHT origin to prevent retrograde extension of Onyx into the parent internal carotid artery.  The patient underwent trans-arterial embolization with Onyx, which resulted in a complete cure of the DAVF.   

Heit Lateral Pre.jpg

Pre-Procedure - LAT View

 

Heit Lateral Roadmap Wire.jpg

Roadmap - Guidewire & Catheter

 

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Post-Procedure Result - LAT View