Single-center experience with a dual microcatheter technique for the endovascular treatment of wide-necked aneurysms

Clinical article

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  • 1 Departments of Radiology and Medical Imaging and
  • 2 Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;
  • 3 Advocate Neurovascular Center, Oak Lawn, Illinois;
  • 4 Borgess Brain & Spine Institute, Kalamazoo, Michigan;
  • 5 Department of Neurological Surgery, Tulane University, New Orleans, Louisiana; and
  • 6 Crouse Radiology Associates Medical Imaging, Syracuse, New York
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Object

The endovascular treatment of wide-necked aneurysms can be technically challenging due to distal coil migration or impingement of the parent vessel. In this paper, the authors illustrate an alternative method for the treatment of wide-necked intracranial aneurysms using a dual microcatheter technique.

Methods

The authors' first 100 consecutive patients who underwent coil embolization of a wide-necked aneurysm using a dual microcatheter technique are reported. With this technique, 2 microcatheters are used to introduce coils into the aneurysm. The coils are deployed either sequentially or concurrently to form a stable construct and prevent coil herniation or migration. Angiographic and clinical outcomes are reported.

Results

The technical success rate of the dual microcatheter technique is 91% with a morbidity and mortality of 1% and 2%, respectively. Clinical outcomes are excellent with 93% of patients demonstrating a modified Rankin Scale score of 0–2 at long-term follow-up regardless of their score at presentation. Retreatment rates are 18%.

Conclusions

The dual microcatheter technique may be a safe and efficacious first line of treatment for widenecked aneurysms.

Abbreviation used in this paper:mRS = modified Rankin Scale.

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Contributor Notes

Drs. Durst and Starke contributed equally to this work.

Address correspondence to: Christopher R. Durst, M.D., Department of Radiology and Medical Imaging, University of Virginia Health System, Box 800170, Charlottesville, VA 22908. email: cdurst@virginia.edu.

Please include this information when citing this paper: published online August 22, 2014; DOI: 10.3171/2014.7.JNS132237.

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