Double Microcatheter Technique Research Articles

Endovascular Treatment of Ruptured Broad-Necked Intracranial Aneurysms with Double Microcatheter Technique: Case Series with Brief Review of Literature.

Objective Treatment of ruptured broad-necked intracranial aneurysms by endovascular therapy is technically burdensome. It is commonly treated with stent- and balloon-assisted coils embolization. The aim of this study was to evaluate clinical and radiological outcomes following double micro-catheter (MC) technique. Materials and Methods A retrospective study was done on 16 broad-necked (neck diameter ≥ 4 mm and dome-to-neck ratio < 2) ruptured intracranial aneurysms in 16 patients treated with double MC technique at our center between December 2021 and December 2023. Clinical outcome was evaluated by modified Rankin Score, postcoiling radiological outcome was evaluated by Raymond-Roy occlusion grade, and treatment-related complications were assessed. Results There were 16 patients, 9 females and 7 males; with a mean age of 51.3 years (35-70 years). All the patients underwent dual MC coils embolization for all aneurysms. Raymond-Roy occlusion class I was achieved in 81.3% (13) cases and Raymond-Roy class II was achieved in 18.7% (3) cases immediately after the procedure. There were no serious postprocedure-related complications or recanalization of the aneurysm at the mean follow-up of 4.8 months (range 2-10 months). Conclusion Our study presents the safety and effectiveness of double MC system for treating ruptured broad-necked intracranial aneurysm. Large numbers of studies with longer follow-up period are required to secure validity of double MC technique.

The safety and efficacy of double microcatheter technique in small and tiny ruptured aneurysms: A single center study.

Double microcatheter technique (dMC) can be the alternative to Single microcatheter technique (sMC) for challenging cases, but there is lack of studies comparing dMC to sMC especifically for small ruptured aneurysms. Our objective was to compare the safety and efficacy of dMC to sMC in treating small (≤5 mm) and tiny (≤3 mm) ruptured aneurysms. This study focused on 91 out of 280 patients who had ruptured aneurysms and underwent either single or double microcatheter coil embolization. These patients were treated with either single or double microcatheter coil embolization. We divided the patients into two groups based on the procedural method and evaluated clinical features and outcomes. Subgroup analyses were conducted specifically for tiny aneurysms, comparing the two methods, and within the dMC group, we also examined whether the aneurysm was tiny or not. In addition, univariate logistic regression analysis was performed to assess the impact of coil packing density. The mean values for most outcome measures in the dMC group were higher than those in the sMC group, but these differences did not reach statistical significance (coil packing density, 45.739% vs. 39.943%; procedural complication, 4.17% vs. 11.94%; recanalization, 8.3% vs. 10.45%; discharge discharge modified Rankin Scale (mRS), 1.83 vs. 1.97). The comparison between tiny aneurysms and other sizes within the dMC group did not reveal any significant differences in terms of worse outcomes or increased risk. The only factor that significantly influenced coil packing density in the univariate logistic regression analysis was the size of the aneurysm (OR 0.309, 95% CI 0.169-0.566, p=0.000). The dMC proved to be a safe and viable alternative to the sMC for treating small ruptured aneurysms in challenging cases.

Safety and Efficacy of the Double Microcatheter Technique for Splenic Artery Aneurysms: A Single-center Retrospective Study.

We aimed to assess the safety and efficacy of the double microcatheter technique in the treatment of saccular splenic artery aneurysms. From November 2013 to October 2020, 56 patients with saccular splenic artery aneurysms underwent endovascular treatment with the double microcatheter technique at our institution. Technical success was defined as embolization of the aneurysmal cavity with no obstruction of the parent artery. Clinical success was defined as no deaths due to splenic artery aneurysms, and no reintervention, recrudescence or organ dysfunction at 1, 6, and 12months. The technical success rate was 100%. No major complications related to angiography or embolization were observed. Minor complications included fever, pain, and nausea, and 13 patients developed minor complications. At 1 month, the rate of clinical success was 96.4%. At 6 and 12months, the clinical success rate was 92.9%. There were no aneurysmal recurrences or necessities of reintervention. Coil embolization with the double microcatheter technique is a safe and effective modality for treating saccular splenic artery aneurysms and offers a reasonable choice for patients who want to retain their original hemodynamics.

Safety and effectiveness of double microcatheter technique in the treatment of ruptured aneurysms of anterior cerebral circulation.

To evaluate the safety and effectiveness of the double microcatheter technique in the treatment of ruptured aneurysms of the anterior cerebral circulation. Between 2012 and 2019, 113 patients with ruptured aneurysms of the anterior cerebral circulation were treated using the double microcatheter technique. Clinical records, angiographic results, and procedure-related complications were reviewed. Clinical and angiographic follow-up was performed. Complete occlusion, neck remnant, and partial occlusion were, respectively, recorded in 56.6, 38.9, and 4.4% of the total cases. For all patients, the incidence of intraoperative complications was 5.3% (6/113), and the overall rate of morbidity was 10.6% (12/113). Before discharge, three patients (2.7%) died. There was no procedure-related mortality. At discharge, favorable outcomes were observed in 79.6% (90/113) of the patients. High Hunt-Hess grades and receiving a craniotomy or external ventricular drainage were risk factors for clinical outcomes at discharge. Clinical follow-up was performed in 91 patients at a mean interval of 14.07 ± 11.68 months. At follow-up, favorable outcomes were observed in 92.3% (84/91) of the patients. Angiographic follow-up was performed in 66 patients at an average of 11.53 ± 11.13 months. The recurrence rate was 37.9%. Of these patients, 13 (19.7%) received retreatment. The double microcatheter technique can be performed in ruptured aneurysms with high technical success and low morbidity/mortality. However, recurrence remains a problem, and patients should be followed up regularly.

Retraction Note to: Improved Endovascular Coiling of Wide-Neck Intracranial Aneurysms in Elderly Patients by Double-Microcatheter Technique.

Retraction Note to: Improved Endovascular Coiling of Wide-Neck Intracranial Aneurysms in Elderly Patients by Double-Microcatheter Technique.

Intra aneurysmal double microcatheter technique for complex aneurysm

Purpose: Wide neck aneurysms can be treated with several methods. In this study, we share our experience of intra aneurysmal double microcatheter technique to treat complex intracranial wide-neck aneurysms with unusual shapes. Materials and Methods: Ten patients with wide-neck intracranial aneurysms were treated using the endovascular method of the double microcatheter between December 2013 to September 2014. All patients had presented with acute subarachnoid hemorrhage on plain CT brain. Detailed demographic information and aneurysm morphology by DSA were noted. Aneurysms were coiled using a double microcatheter technique. Follow up done up to 1 year. Result: All aneurysms were completely embolised using a double microcatheter technique. DSA has done immediately post embolization showed class I filling in 9 patients and class II filling in 1 patient using the Raymond-Roy Classification system. The mean neck diameter was2.91 mm (range 2 to 4 mm) and the mean dome of neck ratio was 1.34 (range 0.89 to 2.14). All these patients were relatively in good grade before the procedure, an improvement was noted during the one year of follow-up. Conclusion: In our series, this modified intra aneurysmal double catheter technique is safe, effective, not costly, and not technically demanding. Keywords: Complex aneurysm, Double microcatheter, Wideneck aneurysm.

Endovascular treatment of wide-necked aneurysms of the visceral and renal arteries using the double microcatheter technique via a single access route

We aimed to evaluate the utility of and complications associated with the double microcatheter technique for the treatment of wide-necked visceral and renal artery aneurysms (VRAAs). Nine patients (mean age, 58 years; age range, 42-69 years; 4 men, 5 women) with wide-necked VRAAs who underwent treatment with the double microcatheter technique from January 2016 to July 2018 were included in the study. For all patients, anatomical features were confirmed using cone-beam computed tomography (CT) with rotational angiography. The aneurysmal location, size, volume, neck-to-dome ratio, number of coils used, and coil packing density were investigated. Technical success, complications (coil migration and organ ischemia), changes in the complete blood count or serum creatine level, and recurrence were also evaluated. Three renal artery aneurysms and 6 splenic artery aneurysms were treated by the double microcatheter technique. The mean size of the aneurysms was 26.09±4.76 mm, mean volume was 6.19±3.69 cm3, and mean neck-to-dome ratio was 1.53±0.24. The number of coils used ranged from 7 to 16. The mean packing density was 11.32%±3.72%. Technical success was achieved in all 9 patients. Renal ischemia occurred in two patients with renal artery aneurysm, one of whom showed minimal scar formation on follow-up CT after infarction. No coil migrations or disease recurrences were observed. The double microcatheter technique for the treatment of wide-necked VRAAs appears to be relatively safe and useful. However, complex renal artery aneurysm should be carefully managed in order to prevent infarction.

Letter to the Editor Regarding “Double Microcatheter Technique within a 5 French Guiding Catheter for Intracranial Aneurysm: Technical Notes”

Letter to the Editor Regarding “Double Microcatheter Technique within a 5 French Guiding Catheter for Intracranial Aneurysm: Technical Notes”

Double Microcatheter Technique Within a 5 French Guiding Catheter for Intracranial Aneurysm: Technical Notes

The double microcatheter technique (DMT) is a common technique for treating intracranial aneurysms with endovascular coiling. The DMT is usually performed with 6 Fr guiding catheters. However, to the best of our knowledge, this technique using 5 Fr guiding catheters has not been reported. We report a DMT using a 5 Fr guiding catheter and the thoughts and tenets to make this possible. An 84-year-old woman had presented with a subarachnoid hemorrhage caused by rupture of a broad-necked aneurysm on the origin of the left posterior inferior cerebellar artery. We decided to use the DMT for coil embolization. However, because of the tortuous and calcified vessels from the femoral artery to the vertebral artery (VA), placement of a 6 Fr guiding catheter within the left VA failed. Therefore, we changed the guiding catheter to a 5 Fr Chaperon guiding catheter, which has the largest inner diameter of the 5 Fr guiding catheters. It was successfully navigated to the left VA, and we performed the DMT using Headway Duo and Prowler 10 microcatheters. Coil embolization was successfully completed without any complications. DMT using a 5 Fr guiding catheter can be performed if the sum of the largest outer diameters of the 2 microcatheters is less than the inner diameter of the 5 Fr guiding catheter. The DMT using a 5 Fr guiding catheter can be performed if the sum of the outer diameters of the 2 microcatheters is less than the inner diameter of the 5 Fr guiding catheter. This technique could be a safe and effective option for treatment of broad-necked aneurysms, especially in the case of an elderly patient with tortuous vasculature or posterior circulation.

Combination of the double-microcatheter technique and triaxial system in coil packing for visceral and renal artery aneurysms.

Background In coil packing for visceral artery aneurysms (VAAs), difficulties are sometimes associated with preserving the patency of the parent artery, particularly for wide-neck aneurysms. However, the double-microcatheter technique effectively prevents coil migration, while the triple-coaxial (triaxial) system is useful for reducing microcatheter kick-back. Purpose To assess the feasibility of combining these two techniques in coil packing for VAAs. Material and Methods Coil packing using the double-microcatheter technique and triaxial system was attempted for seven VAAs in six patients between August 2015 and January 2018. The technical success rate, packing density of aneurysms, complications related to the procedure, and occlusion status were evaluated. Technical success was defined as the completion of coil packing by immediate post-embolic angiography. The occlusion status was evaluated using time-resolved magnetic resonance angiography. Results There were three renal, three splenic, and one anterior superior pancreaticoduodenal aneurysms. The median size of VAAs was 13 mm (range = 8–21 mm), with five being classified as wide-neck aneurysms. The completion of coil packing was confirmed for all VAAs and the technical success rate was 100%. The median packing density was 28% (range = 22–40%). There were no complications related to the procedure. The median follow-up period was 14 months (range = 8–24 months). In six VAAs that were followed up, there were three complete occlusions, three neck remnants, and no body filling; re-treatment was not required in any patient. Conclusion The combination of the double-microcatheter technique and triaxial system is a feasible method of coil packing for VAAs.

Feasibility and Midterm Outcomes of Endovascular Coil Embolization of an Unruptured Middle Cerebral Artery Aneurysm with an Incorporated Branch

Endovascular coiling has emerged as an option for the management of unruptured intracranial aneurysms, which was traditionally treated via surgical clipping. Unlike aneurysms elsewhere, aneurysms of the middle cerebral artery (MCA) have several features that are favorable for surgery. However, endovascular treatment can be difficult for MCA aneurysms, especially if they have incorporated branches. We report the results of coil embolization of incorporated MCA aneurysms. From 2012 to 2017, 129 unruptured aneurysms including 10 incorporated MCA aneurysms were treated. The mean neck, height, and width of the aneurysms were 3.74 ± 1.07, 4.26 ± 1.06, and 3.97 ± 1.03, respectively. The mean aspect ratio, neck/sac width, and sac width/neck were 1.19 ± 0.37, 1.09 ± 0.21, and 0.95 ± 0.18, respectively. Nine cases of incorporated MCA aneurysms were treated using the double microcatheter technique, whereas the triple microcatheter technique was used in 1 case. There were no procedure-related complications. Postcoiling angiograms showed that 4 aneurysms achieved complete occlusion (40%), 5 had a remnant neck (50%), and 1 had a remnant sac (10%). During the follow-up period, (26.0 ± 4.5 months; range, 3-49 months), there were no incidents of recurrence and bleeding. One patient experienced a small cerebral infarction 1 month after the procedure, but it did not lead to any permanent neurologic deficits. Branch-incorporated MCA aneurysms can be treated with coil embolization, with few procedural complications and midterm durability with appropriate techniques and devices.

Double microcatheter technique.

Double microcatheter technique.

Endovascular treatment of irregular and complicated intracranial aneurysms with coils using double microcatheter technique.

Embolisation of irregular and complicated aneurysms is a great challenge for neuroradiologists. To overcome possible complications of endovascular treatment of these type of aneurysms, methods such as intracranial stents, balloon remodelling, and the double microcatheter technique have been developed. The aim of the study was to report our preliminary experience with endovascular treatment of irregular and complicated intracranial aneurysm with coils using double microcatheter technique, and evaluation of its feasibility and clinical advantages. In this retrospective study, 37 cases diagnosed with irregular and complicated intracranial aneurysms and treated using double microcatheter method from July, 2013 to May, 2015, were followed up for six months after discharge. All the aneurysms were successfully embolized using the double microcatheter technique. Immediate post-embolization angiography showed no residual contrast filling in 35 cases, and residual filling in 2 cases. At discharge, according to the modified Rankin Scale score, all the patients recovered without any complications or death. A follow-up of 24 cases with digital subtraction angiography for 6 months revealed no recanalization. In conclusion, the double microcatheter technique for irregular intracranial aneurysms is effective and simple with few complications.

Endovascular treatment of irregular and complicated intracranial aneurysms with coils by double microcatheter technique

Objectives To summarize the preliminary experience of endovascular treatment of irregular and complicated intracranial aneurysms with double microcatheter technique and to investigate the feasibility of its application. Methods From January 2012 to May 2015, the clinical data of 37 patients with irregular and complicated intracranial aneurysm admitted to the Department of Neurosurgery, Anhui Provincial Hospital were analyzed retrospectively. All 37 patients were treated endovascularly by using double microcatheter technique, 33 of them were treated with double microcatheter technique alone and 4 were treated with stent-assisted double microcatheter technique. Prognosis of patients were evaluated by the Glasgow outcome scale (GOS). The follow-up time after procedure was 6 months. Results Immediate angiography after procedure in 37 patients revealed that the aneurysms of 35 patients were densely embolized and 2 were near-totally embolized. All patients recovered well (GOS grade V), no complications and deaths occurred. After 6 months, 24 patients were followed up by DSA, and it revealed that the parent arteries were patent, and no recurrence of aneurysms was found. Thirteen patients were lost to follow-up. Conclusion The efficacy of double microcatheter technique for the treatment of irregular and complicated intracranial aneurysms is good and it has feasibility. Key words: Intracranial aneurysm; Double microcatheter technique; Endovascular procedures

Double Coaxial Microcatheter Technique for Glue Embolization of Renal Arteriovenous Malformations.

To demonstrate the technical benefit of the double coaxial microcatheter technique for embolization of renal arteriovenous malformations (AVMs) with n-butyl cyanoacrylate and iodized oil (glue). Six consecutive patients (1 man and 5 women; mean age 61 years; range 44-77 years) with renal AVMs were included. Five patients had hematuria, and one had a risk of heart failure due to a large intrarenal arteriovenous shunt. All patients underwent transarterial embolization using glue and the double coaxial microcatheter technique with outer 2.6F and inner 1.9F microcatheters. After glue injection, the inner microcatheter was retracted, while the outer microcatheter was retained. We assessed the complications and clinical outcomes of this technique. Technical success was achieved in all patients. In 9 sessions, 34 feeding arteries were embolized with glue using the double coaxial microcatheter technique, 1 was embolized with glue using a single microcatheter, and 2 were embolized with coils. The double coaxial microcatheter technique was useful for selecting small tortuous feeding arteries, preventing glue reflux to the proximal arteries, and approaching multiple feeding arteries without complete retraction of the microcatheters. As a minor complication, glue migrated into the venous system in four patients without any sequelae. In all patients, favorable clinical outcomes, including hematuria cessation in five patients and improvement of the large intrarenal arteriovenous shunt in one patient, were obtained without deterioration of renal function. Glue embolization with the double coaxial microcatheter technique was useful for treating renal AVMs with multiple tortuous feeding arteries.

The application of double microcatheter technique for the treatment of complicated intracranial aneurysms

Objective To evaluate the feasibility and efficiency of endovascular treatment for complicated intracranial by using double microcatheter technique. Methods A retrospective study was applied on 18 cases with complicated intracranial aneurysms which were treated by using double microcatheter method from April 2007 to March 2013. Among them, 9 were wide-necked aneurysms; 8 were irregular aneurysm; and 1 dissecting aneurysm was embolized by using femoral arterial puncture on both sides, on side was assistant by stent placement technology, and the other side was assistant by microcatheter. Results All the aneurysms were managed embolization without the parent arteries occlusion. And in the 6 months to 2 year follow-up period, no recanalization was found. Conclusion According to the clinical date, double microcatheter technique is an efficient, safety and feasible method for coil embolization of complicated intracranial aneurysms. Key words: Intracranial aneurysm; Double microcatheter technique; Endovascular treatment

脳動脈瘤塞栓術に際し血管陰影の重なりにより適切なworking projection image が得られない場合の double microcatheter technique を応用した対処法

【目的】血管陰影が重なり最適なworking projection image（WPI）が得難い動脈瘤に対しdouble microcatheter technique （DMT）を応用し対処したので報告する．【症例】破裂前交通動脈瘤症例．A2 温存のためのworking projection で動脈瘤と内頚動脈が重なるため，DMT を応用した．2 本のmicrocathete（r MC）の一方を造影用としてA1 に留置し，重なりのない画像を取得した．もう一方でframe 形成後，造影用MC も塞栓に用い手技を完遂した．【結論】血管陰影が重なり適切なWPI が得難い場合にDMT を応用した方法は簡便かつ有用である．

Improved Endovascular Coiling of Wide-Neck Intracranial Aneurysms in Elderly Patients by Double-Microcatheter Technique.

Elderly patients are more susceptible to intracranial aneurysms. However, many of them are poor surgical candidates and often have to undergo endovascular treatment. The purpose of this study was to evaluate the efficacy and safety of double-microcatheter technique as an alternative to a balloon- or stent-assisted techniques for wide-neck aneurysms in elderly patients. A retrospective review of 58 patients with 58 wide-neck aneurysms treated with the double-microcatheter technique between October 2010 and December 2012 was performed. Immediate post-embolization angiograms were evaluated using a conventional angiographic scale, and clinical evaluation was performed using the Glasgow Outcome Scale. Clinical and imaging follow-ups were available in 32 (55%) patients, with a mean of 12.5 months. Post-embolization angiograms demonstrated total occlusion in 46 of 58 (79%) aneurysms, a neck remnant in 7 (13%), and body filling in 5 (8%). The technique-related complication rate was 5% (3/58), and the procedural-related mortality rate was 0. Of the 32 aneurysms with follow-ups, recanalization developed in 3 (9%) aneurysms, and none received re-treatment. Using double-microcatheter technique for embolization of wide-neck intracranial aneurysms is safe and effective in the elderly patients. This technique is feasible and safe for coil embolization of wide-neck aneurysms, especially in cases, which are not suitable for balloon- or stent-assisted techniques.

Coil embolization of overwide and undertall small intracranial aneurysms with double microcatheter technique

Overwide and undertall small intracranial aneurysms remain a challenge for coil embolization. The purpose of this study is to evaluate the feasibility and results of intrasaccular double microcatheter endovascular coil embolization of overwide and undertall small intracranial aneurysms. Small (<7mm), overwide (dome-to-neck ratio [DNR] ≤1.2), and undertall (ASPECT ratio ≤1.2) aneurysms which were treated with double microcatheter technique were selected. For the double microcatheter technique, two microcatheters were selected simultaneously into the aneurysm sac and coil insertion was performed alternatingly. The initial results, ASPECT, DNR ratios, complications, and follow-up results were assessed. Twenty small (mean, 3.8mm), overwide (mean DNR, 1.1), and undertall (mean ASPECT, 1.0) aneurysms were treated with the double microcatheter technique. Overall, complete or near complete occlusion was achieved in 19/20 cases. This was achieved with only the double microcatheter technique in 16/20 cases (ASPECT mean, 1.0; DNR mean, 1.1). Adjuvant balloon remodeling was performed in 4/20 cases (ASPECT mean, 0.8; DNR mean, 1.1). The ASPECT ratio was significantly lower in the adjuvant balloon remodeling cases (p = 0.027). Coiling failed in one patient with both DNR and ASPECT ratio <1.0. Overall, one patient developed a focal visual field defect after the procedure. No other patients developed neurologically significant complications. Double microcatheter technique may be a safe and effective method for the treatment of overwide and undertall small intracranial aneurysms.

Double Coaxial Microcatheter Technique for Transarterial Aneurysm Sac Embolization of Type II Endoleaks after Endovascular Abdominal Aortic Repair

PurposeTo evaluate the feasibility and efficacy of transarterial sac embolization with a mixture of N-butyl cyanoacrylate and ethiodized oil (Lipiodol; Guerbet Japan, Tokyo, Japan) (NBCA-LPD) for type II endoleaks after endovascular aortic repair (EVAR) using a double coaxial microcatheter technique. Materials and MethodsA retrospective review was performed of 20 consecutive cases of type II endoleaks treated by transarterial embolization using the technique from August 2010 to June 2013. The treatment indication was persistent type II endoleak over 6 months after EVAR associated with aneurysm expansion ≥ 5 mm in maximum diameter. A 1.9-F nontapered microcatheter was advanced to the aneurysmal sac through a 2.7-F microcatheter, which was coaxially introduced through a catheter. The endpoint of the procedure was intrasaccular filling with NBCA-LPD and occlusion of the feeder of the type II endoleak. The technical success rate was defined as success in transarterial intrasaccular approach followed by embolization of the intrasaccular channel and inflow arteries. Clinical success was defined as aneurysmal sac shrinkage or stabilization (freedom from sac expansion > 5 mm in maximum diameter). ResultsTechnical success was achieved in 18 of 20 cases. During a mean follow-up period of 18.5 months, complete sac occlusion was observed in 13 cases (65%). Clinical success was achieved in 16 cases (80%). No serious complications were observed. ConclusionsThe transarterial intrasaccular approach with a double coaxial microcatheter technique can be successfully performed in most cases, and transarterial aneurysm sac embolization using NBCA-LPD has been proven to be feasible.