Distal Anchoring [Neurosurgery Wiki]

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====== Distal Anchoring ======

**Distal anchoring** is a neurointerventional technique in which a device (such as a **balloon**, **coil**, or **guidewire**) is **intentionally placed in a distal (farther) segment of the vessel** beyond the target lesion (e.g., aneurysm) to provide **mechanical stability** and allow precise navigation, deployment, or treatment upstream (proximally).

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### 🧠 Key Concept:

> **"Fix the back end to control the front."**
> By anchoring distally, you **immobilize the system downstream**, so that the **microcatheter or stent can be deployed more accurately upstream** without recoiling, looping, or herniating into the aneurysm.

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### 🔧 Common Methods of Distal Anchoring:

1. **Balloon anchoring**
   A compliant balloon is inflated distally in a branch vessel (e.g., M2 segment) to **stabilize the microcatheter** while navigating across a wide-necked aneurysm.

2. **Coil anchoring**
   A framing coil is deployed (but not detached) in a distal vessel to **temporarily lock** the microcatheter in place.

3. **Wire anchoring**
   A microguidewire is deeply wedged into a distal vessel, providing tension and **support against backsliding**.

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### 🧪 Example Use Case:

> In treating a large wide-necked basilar tip aneurysm, the interventionist used **distal balloon anchoring** in the posterior cerebral artery to navigate a stent across the aneurysm neck via the **around-the-world technique**.

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### ✅ Advantages:

* Enables treatment in **complex, tortuous anatomy**
* Improves **catheter stability** across wide-necked aneurysms
* Reduces risk of **catheter prolapse** or **device misdeployment**