{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:49:37Z","timestamp":1786124977311,"version":"build-2736575974"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2020,12,15]],"date-time":"2020-12-15T00:00:00Z","timestamp":1607990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Wide-necked aneurysms often pose challenges for distal access to the distal vasculature. This 64-yr-old woman without neurological deficits presented with atypical headaches of gradual onset. MRI revealed a large, symptomatic, unruptured carotid terminus aneurysm incorporating the origin of both the middle (MCA) and anterior cerebral arteries (ACA). Its wide neck created significant risks to coil prolapse and parent vessel compromise, risking stroke. With other options of higher risks, we recommended an around-the-world technique. Standard transfemoral access was used to the right internal carotid artery (ICA) with a 6F-Shuttle sheath and intracranial carotid with a 6F-Sofia distal access catheter. With dual-microcatheter access, 1 catheter was placed in the aneurysm dome, a second in the MCA for stent placement. Advancing the wire around the aneurysm first formed a loop from the lateral to medial wall for access to the MCA. The microcatheter was then advanced around the wire into the MCA, keeping the loop within the dome. With the loop's distal tip anchored, the distal end of the stent was deployed and anchored into the MCA. Both pitfalls (ie, lack of sufficient distal access, collapse of stent device during deployment) were resolved using a balloon catheter. With the balloon positioned and inflated as the anchor, the wire and catheter were pulled together. The loop in the aneurysm's dome straightened out across the neck, the stent was advanced into the MCA, and coiling proceeded. A large neck remnant had partially closed on 6-mo follow-up angiogram. Patient consented to undergo the procedure.<\/jats:p>\n                  <jats:p>Illustrations in video published\/printed with permission from Mayfield Clinic.<\/jats:p>","DOI":"10.1093\/ons\/opaa369","type":"journal-article","created":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T20:08:29Z","timestamp":1607976509000},"page":"E39-E40","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Distal Access to Wide-Necked Aneurysms\u2014\u2018Around the World\u2019 Technique: 2-Dimensional Operative Video"],"prefix":"10.1227","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2524-3426","authenticated-orcid":false,"given":"Andrew J","family":"Ringer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Endovascular Neurosurgery Research Group (ENRG)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Arthur","sequence":"additional","affiliation":[{"name":"University of TN\/Semmes-Murphey Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bain","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Bendock","sequence":"additional","affiliation":[{"name":"Mayo Clinic Scottsdale"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandy Jo","family":"Binning","sequence":"additional","affiliation":[{"name":"Capital Health; Stroke & CV Center of New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan S","family":"Boulos","sequence":"additional","affiliation":[{"name":"Albany Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Webster","family":"Crowley","sequence":"additional","affiliation":[{"name":"Rush University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Fessler","sequence":"additional","affiliation":[{"name":"Wayne State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Grande","sequence":"additional","affiliation":[{"name":"University of Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee","family":"Guterman","sequence":"additional","affiliation":[{"name":"Buffalo Neurosurgery Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Hanel","sequence":"additional","affiliation":[{"name":"Baptist Health System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Hoit","sequence":"additional","affiliation":[{"name":"University of TN\/Semmes-Murphey Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L Nelson","family":"Hopkins","sequence":"additional","affiliation":[{"name":"University at Buffalo Neurosurgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Howington","sequence":"additional","affiliation":[{"name":"Neurological Institute of Savannah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"James","sequence":"additional","affiliation":[{"name":"University of Louisville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Jankowitz","sequence":"additional","affiliation":[{"name":"Cooper University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kan","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex A","family":"Khalessi","sequence":"additional","affiliation":[{"name":"UC San Diego"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Kim","sequence":"additional","affiliation":[{"name":"University of Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Langer","sequence":"additional","affiliation":[{"name":"Hofstra North Shore-LIJ School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Lanzino","sequence":"additional","affiliation":[{"name":"Mayo Clinic Rochester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Levitt","sequence":"additional","affiliation":[{"name":"University of Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elad","family":"Levy","sequence":"additional","affiliation":[{"name":"University at Buffalo Neurosurgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Demetrius","family":"Lopes","sequence":"additional","affiliation":[{"name":"Rush University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Mack","sequence":"additional","affiliation":[{"name":"U Southern California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Mericle","sequence":"additional","affiliation":[{"name":"HW Neurological Institute, LLC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Mocco","sequence":"additional","affiliation":[{"name":"Mount Sinai"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Ogilvy","sequence":"additional","affiliation":[{"name":"Harvard - Beth Israel Deaconess Medical Ctr"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya","family":"Pandey","sequence":"additional","affiliation":[{"name":"University of Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Replogle","sequence":"additional","affiliation":[{"name":"University of Rochester Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Riina","sequence":"additional","affiliation":[{"name":"Cornell University\/Weill Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Ringer","sequence":"additional","affiliation":[{"name":"Mayfield Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"University of Puerto Rico Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Saugaveau","sequence":"additional","affiliation":[{"name":"Baptist Health System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens","family":"Schirmer","sequence":"additional","affiliation":[{"name":"Geisinger Neurosurgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"University at Buffalo Neurosurgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Spiotta","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Sultan","sequence":"additional","affiliation":[{"name":"Harvard - Brigham and Women's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabih","family":"Tawk","sequence":"additional","affiliation":[{"name":"Mayo Clinic Jacksonville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajith","family":"Thomas","sequence":"additional","affiliation":[{"name":"Harvard - Beth Israel Deaconess Medical Ctr"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Turner","sequence":"additional","affiliation":[{"name":"Prisma Health - Greenville, SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erol","family":"Veznedaroglu","sequence":"additional","affiliation":[{"name":"Capital Health; Stroke & CV Center of New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babu","family":"Welch","sequence":"additional","affiliation":[{"name":"UT Southwestern Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"White","sequence":"additional","affiliation":[{"name":"UT Southwestern Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,1]]},"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/article-pdf\/20\/1\/E39\/34880005\/opaa369.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opaa369","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:48:20Z","timestamp":1786121300000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opaa369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,15]]},"references-count":0,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opaa369","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,15]]},"assertion":[{"value":"2020-07-15","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-20","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}