Abstract
BackgroundDelivery of most flow diverters (FD) requires larger, and thus stiffer microcatheters (0.021–0.027in.) which can pose challenges to intracranial navigation. The concomitant use of two microwires within one microcatheter, also known as the buddy-wire technique, may be helpful for navigation and support in challenging situations.MethodsWe analyzed all flow diverter procedures in our prospectively collected database. We recorded all patient-related, anatomical and procedural information. We performed univariate statistics and technical descriptions.ResultsIn total, 208 consecutive patients treated with a FD at our institution between July 2014 and August 2020 were retrospectively analyzed. In 17 patients the buddy-wire technique was used (mean age 63 years, range 31–87 years: 16 female). Aneurysms were located at the petrous, cavernous, supraophthalmic internal carotid artery, and a proximal M2 branch in 2, 7, 7 and 1 patient(s), respectively. In all cases a 0.027in. microcatheter was used for device deployment. In 14 patients with a wide-necked aneurysm the buddy-wire provided additional support to advance the microcatheter and mitigated the ledge between the aneurysm neck and the parent artery or a side branch. In two giant cavernous aneurysms treated with telescoping FDs, the buddy-wire was used to re-enter the proximal end of the foreshortened FD.ConclusionThe buddy-wire is a useful technique in FD procedures to prevent herniation of the microcatheter into the aneurysm sack, in wide-necked aneurysms to mitigate the ledge effect between the aneurysm neck and the parent artery where the microcatheter tip may get stuck, or to enable re-entry into a foreshortened FD.
Highlights
Endovascular treatment is revolutionizing intracranial aneurysm (IA) management and continues to expand with technological advances, such as flow diverting (FD) stents
We have demonstrated that in approximately 10% of flow diverters (FD) cases, there are situations in which despite good proximal support, the appropriate positioning of the 0.027in. microcatheter distal to the aneurysm or access into an already deployed FD is not possible
In this technical report we describe a potential solution—the buddy wire technique—by adding a 0.010in. microwire alongside a 0.014in. guidewire within a 0.027in. microcatheter
Summary
Endovascular treatment is revolutionizing intracranial aneurysm (IA) management and continues to expand with technological advances, such as flow diverting (FD) stents. The FD promote flow reduction and subsequent aneurysmal thrombosis in addition to vessel remodeling [1]. This has enabled occlusion of large wide-necked and fusiform aneurysms that were previously deemed difficult to treat or required deconstructive treatment (parent vessel occlusion) [2,3,4,5,6]. Delivery of most flow diverters (FD) requires larger, and stiffer microcatheters (0.021–0.027in.) which can pose challenges to intracranial navigation. The concomitant use of two microwires within one microcatheter, known as the buddy-wire technique, may be helpful for navigation and support in challenging situations
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
