Successful Treatment of a Ruptured Left Internal Carotid Artery Aneurysm with a Type III Aortic Arch Using an α-shaped Guiding Catheter: A Technical Case Report

In endovascular therapy, the induction and stable placement of the guiding catheter (GC) are not only the initial steps but also crucial techniques influencing treatment success. However, in some cases, GC induction is challenging due to variations in the aortic arch or tortuosity of the blood vessels. In the present case, endovascular therapy was carried out for a ruptured aneurysm in the dorsal portion of the left internal carotid artery. However, conventional GC could not be induced because of the type III aortic arch and extremely steep angle. By switching to an α-shaped GC, employed in conjunction with a distal access catheter, we were able to reach the aneurysm with a microcatheter and successfully complete the treatment. The tip of the α-shaped GC was positioned in the ascending aorta and thus required various considerations in terms of setup and device selection when compared to conventional techniques. This is the first report of the use of this catheter for the acute treatment of ruptured cerebral aneurysms. In this report, we share our experience and the effectiveness of using this catheter while highlighting our considerations.