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Accurate Placement of Flow Diverter Device Supported by syngo DynaCT Courtesy of Ciceri Elisa, MD, Faragò Giuseppe, MD, Caldiera Valentina, MD, Sagaria Nazario, and Listrani Massimiliano Treatment After one week double anti-platelet therapy the procedure was performed under general anesthesia and systemic heparinization. The syngo InSpace 3D rotational angiography visualized the aneurysmal sac and the morphological details of the surrounding vessels by VRT reconstructions. The best working position was determined and correct measurements of the parent artery were performed in order to correctly choose the dimension of the PED (Fig. 1c). The procedure was performed under syngo iPilot guidance merged with standard roadmap DSA, to provide the best 3D live roadmap visualization during PED positioning (Fig. 2). Patient History 68-year-old female, with several years’ history of headache, referred for neurological evaluation and treatment after incidental finding of a wide-neck carotid-ophthalmic aneurysm. Diagnosis Angio-CT and MRI demonstrated the presence of a left paraophthalmic aneurysm. The aneurysm measures 8 mm in its largest diameter, with a neck of 6 mm. The ophthalmic artery arises in proximity to the aneurysmal neck (Fig. 1A and 1B). After collegial discussion with the neurologists and neurosurgeons, endovascular treatment was suggested. Benefits and risks of the treatment were discussed with the patient, and finally the procedure was performed successfully utilizing a flow diverter device (PED) (Pipeline, ev3, Irvine, California). Comments The PED was carefully deployed across the aneurysmal neck. A final syngo DynaCT acquisition precisely showed the relationship between the PED, the parent artery, and the ophthalmic artery (Fig. 3). Additionally, to clarify the position of the PED at the level of the tortuous carotid siphon, a fusion with MRI and syngo DynaCT image reconstruction was performed (Fig. 4). The procedure was arranged without any technical or clinical complications and the patient returned for the 6-month follow-up angiography that showed complete disappearance of the aneurysm with preservation of the antegrade flow in the ophthalmic artery (Fig. 5). Neurological Institute C. Besta, Milan, Italy 3D-Time-of-flight-MR, axial (A), MIP coronal reconstructions (B) and 3D rotational angiography VRT reconstruction (C) of the left internal carotid artery. The ophthalmic artery origin is close to the aneurysmal neck (arrow). Note pre-treatment measurements of the parent artery and of the aneurysmal sac. 1 1A 1B 1C Contact stefano.boriotti@siemens.com Angiography syngo iPilot 28  AXIOM Innovations | December 2013 | www.siemens.com/angiography


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