Double microcatheter technique for coil embolization of small aneurysms with unfavorable configurations: A comparative study of the aneurysms that are ≤3 mm or >3 mm.

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The endovascular coiling of small ruptured aneurysms with difficult geometries presents a significant treatment challenge. We report our initial experience and the technical details of dual microcatheter coil embolizations that were applied in these difficult lesions. Eighty-five small aneurysms (<7 mm) that exhibited difficult configurations, such as a wide neck or an important branch vessel arising from the fundus, were successfully treated using a dual microcatheter technique. The packing attenuation, adverse events during the procedures, and angiographic occlusions from 21 very small aneurysm (≤3 mm) were recorded and compared with our coiling results of 64 small aneurysms (>3 mm, <7 mm). There were no significant differences in intraprocedural ruptures or procedure-related thromboembolisms between the two groups. At the last post-procedure clinical follow-up, a good clinical outcome (an modified Rankin Scale (mRS) of 0-2) was observed in 18 of the patients (85.7%). The recanalization rates at follow-up were significantly lower in the very small aneurysm group compared to the small aneurysm group (p < 0.05) and the mean packing density in the very small aneurysm group was significantly higher compared to the small aneurysm group (35.2% vs 24.8%, p < 0.05). The dual technique was feasible, safe, and effective for coil embolization of aneurysms with difficult configurations and, in particular, it provided an alternative option for treating very small aneurysms.