The retrograde approach: A consideration for the endovascular treatment ofaneurysms

BACKGROUND AND PURPOSE: The traditional endovascular approach to a cerebral aneurysm is anterograde, with the embolization and balloon protection cath eters introduced via the parent vessel. Unfortunately, this approach may be restrictive, because these catheters cannot always be navigated at an opti mal angle into the arterial branch that needs balloon protection or the par t of the aneurysm that needs coiling. The purpose of this study was to dete rmine the efficacy of a retrograde approach, METHODS: Twelve patients, seven women and five men, 28 to 65 years old (mea n age, 45 years), were treated via the retrograde approach between March 19 98 and February 1999, Three patients were treated for acutely ruptured aneu rysms following subarachnoid hemorrhage, The rest had asymptomatic, unruptu red aneurysms. RESULTS: We were able to accomplish endovascular treatment in 10 cases. In the other two, the attempted retrograde route of access could not be achiev ed. The treatment afforded complete embolization in nine of the 10 patients . Symptomatic distal clot embolization occurred in one patient who had some residual, albeit improving, deficits at discharge. No other patients worse ned with the treatment, There were two intraprocedural aneurysmal ruptures. None of the aneurysms restudied within 6 months (eight of 12) showed evide nce of recanalization, CONCLUSION: Our results indicate that it is possible to safely and effectiv ely access a cerebral aneurysm via a retrograde approach. We believe that t he anatomic benefits afforded by this technique outweigh the potential risk s associated with the catheterization of another major cerebral arterial fe eder.