Treatment of a middle cerebral artery bifurcation aneurysm with the novel Contour Neurovascular System compatible with 0.021″ catheters

Abstract

Background: For wide-necked intracranial aneurysms, endo-saccular flow disruption can be a viable alternative to coiling or flow diverters. The Contour Neurovascular System is an intrasaccular flow diverter device targeting the neck of the aneurysm. Until now, the system had to be delivered through a 0.02700 microcatheter. We report the first implantation and follow-up of the novel Contour 021 system compatible with 0.02100 microcatheters. Case presentation: A 54-year-old male patient presented with an unruptured right middle cerebral artery aneurysm at the right temporopolar branch. Existing medication included apixaban. An arteriogram showed a broad-based aneurysm. Due to its asymmetric geometry, neither the Woven EndoBridge nor stent-assisted coil embolisation were regarded as promising treatment strategies. To uphold the option of different treatment options, prasugrel 10 mg was initiated before treatment. Implantation was performed under general anaesthesia via femoral artery puncture. A 0.02100 HeadwayTM catheter was used for accessing the aneurysm. The Contour device was oversized to the equatorial plane. Deployment was successful with only one attempt without the need for re-sheathing. Follow-up catheter angiography was performed after three months, showing complete occlusion of the aneurysm. No procedure-related complications occurred. Conclusion: The 0.021 design of the Contour enlarges the subgroup of patients that can be treated with endo-saccular devices and will enable treatment of smaller and more distal aneurysms.