Double microcatheter technique for coiling intracranial aneurysms with unfavorable configurations

Abstract

Background Although stent⁃assisted technique has been widely used clinically, it is still hard to perform coiling treatment for complicated intracranial aneurysms, including relatively wide-necked tiny aneurysms and lobulated wide-necked aneurysms with important branch vessels arising from the neck. This study aims to investigate the feasibility and clinical results of endovascular treatment for intracranial aneurysms with unfavorable configurations by using double microcatheter technique. Methods Thirty-three cases with complicated aneurysms were treated by using double microcatheter technique from April 2008 to November 2012. The locations of these aneurysms were anterior communicating artery (7 cases), posterior communicating artery (14 cases), ophthalmic artery (3 cases), anterior choroidal artery (3 cases), origin of posterior inferior cerebellar artery (3 cases), bifurcation of middle cerebral artery (2 cases) and top of basilar artery (1 case). The mean neck-to-body (width) ratio was 0.80 ± 0.21 (0.53-1.33). The mean body (width)-to-dome (height) ratio was 1.12 ± 0.37 (0.55-2.12). The mean dome (height)⁃to⁃neck ratio was 1.26 ± 0.41 (0.65-2.96). The diameter of neck ≥ 4 mm was seen in 7 aneurysms, neck ≥ height in 9 and neck ≥ width in 8. Besides, there were 9 very small aneurysms (the maximum diameter ≤ 3 mm) and 13 aneurysms with important branch vessels arising from the neck. All of these aneurysms were treated with coiling by using double microcatheter technique. Results All aneurysms were successfully embolized. Immediate postembolization angiography showed no residual contrast filling in 19 aneurysms, and residual filling in 14. There were some small loops protruding from the neck without influencing the blood flow in 12 cases. At discharge, according to modified Rankin Scale (mRS), 30 patients with 0-1 scores presented excellent clinical outcomes and 3 patients with 2 scores had cognitive dysfunction and moderate disability due to vasospasm. Among the 33 cases, only 1 case receiving follow-up angiography 1 year after operation showed the coils near the neck were slightly compressed and presented a "dog ear" like recanalization. Conclusion According to the clinical experience with complicated aneurysms, double microcatheter technique is feasible, safe and effective for coil embolization of aneurysms with unfavorable configurations.