The Egyptian Escalator: Gaining access to distal parent vessel in giant and large aneurysms.

Flow-diverter stents have become the mainstay of endovascular treatment for giant and large intracranial aneurysms. However, the local aneurysmal hemodynamics, the incorporation of the parent vessel and the frequent wide-neck configuration render gaining stable distal parent artery access difficult. In this technical video, we present three cases in which we employed the so called "Egyptian Escalator technique" for obtaining and maintaining stable distal access: after looping the microwire and microcatheter inside the aneurysmal sac and exiting in the distal parent artery, we deployed a stent-retriever and utilized a gentle traction on the microcatheter in order to straighten the intra-aneurysmal loop. Afterwards, a flow-diverter stent was deployed, with optimal coverage of the aneurysmal neck. The "Egyptian Escalator" technique provides a useful approach for obtaining stable distal access for flow-diverter deployment in giant and large aneurysm (supplementary mmc1 (Video 1)).

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Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare the following financial or personal relationships that could be viewed as influencing the work reported in this paper Pr F. Clarençon reports conflict of interest with Medtronic, Guerbet, Balt Extrusion, Penumbra (payment for readings; non-related to the study), Codman Neurovascular and Microvention (core lab; non-related to the study). N. Sourour is consultant for Medtronic, Balt Extrusion, Microvention.