Embolization Of Wide-necked Aneurysms Research Articles

Rescue stenting after artery occlusion as a complication of an intrasaccular device-assisted coiling embolization: illustrative case.

Endovascular embolization of wide-necked aneurysms can be challenging. The development of intrasaccular devices like the Contour has enabled us to approach these aneurysms effectively by reducing recanalization rates and eliminating the need for dual antiplatelet therapy, which is particularly beneficial in the case of ruptured aneurysms. Although complications from using these devices are rare, it is crucial to address them properly. In this case, the authors highlight how to manage artery thrombosis caused by device protrusion during aneurysm embolization. This report describes a complication in a male patient with a ruptured anterior communicating artery wide-necked aneurysm. Following Contour-assisted coiling of the aneurysm, a realignment of the detachable apex of the device occluded the A2 segment of the right anterior cerebral artery. After the failure of intra-arterial and intravenous tirofiban infusion as well as mechanical thrombectomy, a self-expanding open-cell stent was deployed in the involved vessel, achieving successful reperfusion. The Contour device has a detachable zone that can cause occlusion of the parent vessel after deployment. The use of a stent as a rescue maneuver may be useful if reperfusion of the vessel cannot be achieved through other methods such as aspiration or full-dose antiplatelet therapy.

Treatment Strategy for Wide-neck Aneurysm Embolization: Temporary Stent-assisted Coil Embolization Using Solitaire Retrieval Stent, A 3-year Single Center Experience

Treatment Strategy for Wide-neck Aneurysm Embolization: Temporary Stent-assisted Coil Embolization Using Solitaire Retrieval Stent, A 3-year Single Center Experience

Determination of the Optimal Ratio and the Relationship Between Viscosity and Adhesion of n-Butyl Cyanoacrylate-Lipiodol-Iopamidol for Balloon-Assisted Embolization of Wide-Neck Aneurysms in Swine.

To determine the optimal ratio of n-butyl cyanoacrylate-Lipiodol-iopamidol (NLI) for balloon-assisted embolization of wide-neck aneurysms in swine. Sixteen NLI mixtures were prepared for in vitro studies. The viscosity of each mixture was measured for 30min. We evaluated whether the mixtures could be injected through a microcatheter and whether they adhered to the microcatheter. In vivo, 15 wide-neck aneurysms were created on the arteries in 4 female swine. Under balloon occlusion, 7 aneurysms were embolized with NLI141 (NBCA:Lipidol:iopamidol = 1:4:1) and 8 were embolized with NLI231. We performed angiography to evaluate adhesion of NLI to the balloons or microcatheters and NLI migration. In vitro, the iopamidol content needed to comprise at least 1/6 of the mixture in order for NLI to be non-adhesive with increased viscosity. NLI could not be injected through a microcatheter if the iopamidol content exceeded 1/6 of the mixture. Only NLI141 and NLI231 did not adhere to the microcatheter with increased viscosity, and could be injected through a microcatheter. In vivo, neither NLI mixture adhered to the balloons or microcatheters. The migration of NLI was observed in 6 of 7 aneurysms embolized with NLI141 and in none of 8 aneurysms embolized with NLI231. Our in vitro study revealed that the ratios of NLI that were non-adhesive and could be injected through a microcatheter were 1:4:1 and 2:3:1. The optimal ratio of NLI for balloon-assisted embolization of wide-neck aneurysms in swine was considered to be 2:3:1.

Rehearsals using patient-specific 3D-printed aneurysm models for simulation of endovascular embolization of complex intracranial aneurysms: 3D SIM study

BackgroundIn neurovascular treatment planning, endovascular devices to manage complex intracranial aneurysms requiring intervention are often selected based on conventional measurements and interventional neuroradiologist experience. A recently developed technology allows a patient-specific 3D-printed model to mimic the navigation experience. The goal of this study was to assess the effect of pre-procedure 3D simulation on procedural and clinical outcomes for wide-neck aneurysm embolization. Materials & methodsIn this unblinded, non-randomized, prospective, multicenter study conducted from November 18 through December 20, patients with complex intracranial aneurysms (neck > 4 mm or ratio < 21) were treated by WEB or flow diverter stents (FDS). The primary endpoint was concordance between simulation and procedure, 3D-printed model accuracy as well as embolization outcomes including complications, procedure times, and radiation dose were also assessed. Secondary endpoint was to compare versus a retrospective WEB cohort. ResultsTwenty-one patients were treated, 76% of cases by WEB and 24% by FDS. Concordance between post-simulation and real procedure efficiency was 0.85 [0.69 – 1.00] for size device selection and 0.93 [0.79 – 1.00] for wall-apposition/aneurysm neck closure. Geometrical accuracy of the 3D-printed model showed a mean absolute shift of 0.11 mm. Two complications without major clinical impact were reported with a post-operative mRS similar to pre-procedure mRS for all patients. ConclusionsRehearsal using accurate 3D-printed patient-specific aneurysm models enabled optimization of embolization strategy, resulting in reduced procedure duration and cumulative fluoroscopy time which translated to reduced radiation exposure compared to procedures performed without simulation.

T-Stent or Half T-Stent-Assisted Embolization of Wide-Necked Aneurysms at the Internal Carotid-Posterior Communicating Artery Bifurcation.

We report the usefulness and pitfalls of coil embolization using the T or half T-stent technique for aneurysms located at internal carotid artery-posterior communicating artery (ICA-P-com) bifurcation in which the neck is wide and the P-com must be kept patent due to it being the fetal-type with a hypoplastic P1 segment. Two cases were treated using the T-stent technique and two were treated using the half T-stent technique. The average age of the patients was 70.3 years and all were females. One aneurysm ruptured. The average size of aneurysms and neck was 12 mm and 8.5 mm, respectively, in the T-stent group, and 7.4 mm and 6.7 mm, respectively, in the half T-stent group. An S- or pigtail-shaped microcatheter (MC) was used to navigate into the P-com. Stent deployment was successful in all the cases. Retreatment was required in one case treated using the T-stent technique due to major recurrence. T or half T-stent-assisted coil embolization can be an alternative endovascular treatment method for wide-necked ICA-P-com aneurysms in which the P-com must be kept patent due to it being the fetal-type with a hypoplastic P1 segment.

Feasibility and Safety of n-Butyl Cyanoacrylate-Lipiodol-Iopamidol as an Alternative Liquid Embolic Material.

To evaluate the feasibility and safety of n-butyl cyanoacrylate (NBCA)-Lipiodol-Iopamidol (NLI) as a liquid embolic material. In vitro, the ratio of NLI components was adjusted and the configuration of the mixtures was assessed visually in saline. In vivo, 14 wide-necked aneurysms were created on the common carotid and external iliac arteries of four female swine. Under balloon occlusion, 12 aneurysms were embolized with NLI prepared at a NBCA-Lipidol-Iopamidol ratio of 2:3:1 (NLI231), and two were embolized with NBCA-Lipiodol (NL) prepared at a NBCA-Lipiodol ratio of 1:2 (NL12) as a trial group. We performed angiography to evaluate the effectiveness of embolization and adhesion of the embolic material to the balloons or microcatheters. In vitro, NLI231 (33% NBCA) was considered to be the optimal ratio for aneurysm embolization based on its configuration and stability. In vivo, embolization using NLI231 was successful and no adhesion between the embolic material and the balloons or microcatheters was observed in all 12 aneurysms. Embolization with NL12 was impossible in the other two aneurysms due to leakage and adhesion of NL. The configuration of NLI changed at each ratio. NLI231 is a feasible and safe liquid embolic material for balloon-assisted embolization of wide-necked aneurysms in swine.

Diverse Use of the WEB Device: A Technical Note on WEB Stenting and WEB Coiling of Complex Aneurysms

The Woven EndoBridge (WEB) device, an intrasaccular flow-diverter that does not require long-term antiplatelet use, has recently emerged as an alternative to embolize complex intracranial aneurysms; however, there are limitations to the WEB device. First, it does not immediately secure the aneurysm in most subarachnoid hemorrhage cases. Second, it may not be suitable for embolization of wide-neck aneurysms with an unfavorable aspect ratio. To overcome these limitations, we have used the WEB device in conjunction with stenting and/or coiling. Here, we present a technical note with an illustrated case series and provide a detailed step-by-step description on how the WEB device can be used in adjunct to coiling and/or stenting to achieve successful angiographic results. Accurate sizing of the WEB device before deployment is critical. Larger case series are required to further assess the safety and success of these combined techniques.

Scaffolding Technique: A New Double-catheter Technique for Coil Embolization of Wide-necked Aneurysms

Scaffolding Technique: A New Double-catheter Technique for Coil Embolization of Wide-necked Aneurysms

The Barrel Vascular Reconstruction Device : ARetrospective, Observational Multicentric Study.

The Barrel device is an electrolytically detachable laser cut, closed-cell microstent that is used for neck reconstruction in wide-necked bifurcation and branching aneurysms to support coiling. The key feature is abarrel section that herniates over the aneurysmal ostium. The objective was to evaluate the safety, feasibility and the immediate and mid-term occlusion results of this new device. The databases of two tertiary care centers were screened for all Barrel-based stent-assisted intracranial coil embolization of wide-necked aneurysms between June 2015 and September 2016. Case files and imaging data were retrospectively analyzed for angiographic and clinical outcome parameters, including immediate and mid-term modified Raymond-Roy aneurysm occlusion classification (RROC) rates and procedural complications. A total of 21 patients comprising 21intracranial aneurysms (20unruptured, 1ruptured) were treated with the Barrel device and additional coiling of the aneurysm sac. All aneurysms were wide-necked, saccular bifurcation aneurysms defined by adome/neck ratio ≤2. Immediate complete occlusion (RROC1) was observed in 19/21 (90%). An intra-interventional in-stent thrombus formation in two cases (10%) was medically resolved without neurological sequelae. Asingle case of symptomatic in-stent stenosis (5%) was cleared by balloon angioplasty. Follow-up (FU) was available in 20/21 cases (95%) after amedian of 282 days (range: 17-591 days). At follow-up 19/20 aneurysms (95%) were completely occluded (RROC1). The Barrel device showed asatisfactory safety profile and apromising rate of immediate and mid-term complete aneurysm occlusion for stent-assisted coil embolization of wide-necked intracranial bifurcation aneurysms, warranting further investigation of the device.

Letter: Results of the ANSWER Trial Using the PulseRider for the Treatment of Broad-Necked, Bifurcation Aneurysms.

Background The safety and probable benefit of the PulseRider (Pulsar Vascular, Los Gatos, California) for the treatment of broad-necked, bifurcation aneurysms was studied in the context of the prospective, nonrandomized, single arm clinical trial-the Adjunctive Neurovascular Support of Wide-neck aneurysm Embolization and Reconstruction (ANSWER) Trial. Objective To present the results of the United States cases employing the PulseRider device as part of the ANSWER clinical trial. Methods Aneurysms treated with the PulseRider device among sites enrolling in the ANSWER trial were prospectively studied and the results are summarized. Aneurysms arising at either the carotid terminus or basilar apex that were relatively broad necked were considered candidates for inclusion into the ANSWER study. Results Thirty-four patients were enrolled (29 female and 5 male) with a mean age of 60.9 years (27 basilar apex and 7 carotid terminus). Mean aneurysm height ranged from 2.4 to 15.9 mm with a mean neck size of 5.2 mm (range 2.3-11.6 mm). In all patients, the device was delivered and deployed. Immediate Raymond I or II occlusion was achieved in 82.4% and progressed to 87.9% at 6-month follow-up. A modified Rankin Score of 2 or less was seen in 94% of patients at 6 months. Conclusion The results from the ANSWER trial demonstrate that the PulseRider device is safe and offers probable benefit as for the treatment of bifurcation aneurysms arising at the basilar apex or carotid terminus. As such, it represents a useful addition to the armamentarium of the neuroendovascular specialist.

Abstract 201: Results of the ANSWER Trial Using the PulseRider for the Treatment of Broad-necked, Bifurcation Aneurysms

Background: The safety and probable benefit of the PulseRider ® (Pulsar Vascular, San Jose, CA) for the treatment of broad-necked, bifurcation aneurysms was studied in the context of the prospective, non-randomized, single arm clinical trial - the Adjunctive Neurovascular Support of Wide-neck aneurysm Embolization and Reconstruction Trial (ANSWER). Objective: We present the results of the United States cases employing the PulseRider ® device as part of the ANSWER clinical trial. Methods: Aneurysms treated with the PulseRider ® device among U.S. sites enrolling in the ANSWER trial were prospectively studied and the results are summarized. Aneurysms arising at either the carotid terminus or basilar apex that were relatively broad necked were considered candidates for inclusion into the ANSWER study. Results: 34 patients were enrolled (29 female and 5 male) with a mean age of 60.9 years (27 basilar apex and 7 carotid terminus). Mean aneurysm height ranged from 2.4 to 15.9 mm with a mean neck size of 5.2 mm (range 2.3 - 11.6 mm). In all patients the device was delivered and deployed. Immediate Raymond I or II occlusion was achieved in 82.4% and progressed to 87.9% at six month follow up. A modified Rankin Score of 2 or less was seen in 94% of patients at 6 months. Conclusions: The results from the U.S. cases of the ANSWER trial demonstrate that the Pulse Rider® device is safe and effective as for the treatment of bifurcation aneurysms arising at the basilar apex or carotid terminus. As such, it represents a useful addition to the armamentarium of the neuroendovascular specialist.

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.

Comparison of clinical and radiologic outcomes among stent-assisted, double-catheter, and balloon-assisted coil embolization of wide neck aneurysms

Endovascular treatment of intracranial aneurysms can be technically challenging in cases of wide necks or unfavorable dome-to-neck ratio. Coils deployed without supporting devices may herniate from the aneurysm sac into the parent artery, causing thromboembolic complications or vessel occlusion. Therefore, alternative strategies for managing wide-necked aneurysms have been introduced such as stent-assisted coil embolization (SAC), balloon-assisted coil embolization (BAC), and double-catheter coil embolization (DCC). SAC, BAC, or DCC were used to treat 201 patients with 207 wide-neck aneurysms between 2008 and 2013. Initial occlusion rates, recanalization rates, and periprocedural complications were retrospectively evaluated. The mean follow-up periods for SAC, BAC, and DCC were 16.2 months, 11.6 months, and 14.3 months, respectively. Clinical and anatomical analyses were conducted in 201 patients with 207 anuerysms. Complete occlusion rates of SAC, DCC, and BAC were 63.8 %, 46.7 %, and 63.2 %, respectively, and incomplete occlusion rates were 13.4 %, 15.5 %, 10.5 %, respectively (p value = 0.798). No rebleeding or hemorrhage occurred after coil embolization. Recanalization rates did not differ among the SAC, DCC, and BAC groups (7.1 % vs. 11.1 % vs. 7.9 %, p value = 0.696). Statistically insignificant results were observed in the rate of periprocedural complications among SAC, DCC, and BAC (11.0 % vs. 13.3 % vs. 15.8 %, p value = 0.578). There were no significant differences in the recurrence rate and periprocedural complication rate, and no rebleeding or aneurysmal rupture after treatment. Sufficient occlusion rates were achieved with SAC, DCC, and BAC. Notably, DCC does not require the use of antiplatelet agents and achieves coil stability without compromising the parent artery or major branch. Thus, we believe that the double-catheter technique was found to be a feasible and safe treatment modality for branching wide-neck aneurysms.

Stent-Assisted Coil Embolization of Posterior Communicating Artery Aneurysms

Use of protective stents may not be effective in coil embolization of wide-neck aneurysms involving the posterior communicating artery. Successful implementation depends on the caliber of the vessel, its angle of origin, and the manner in which its orifice is incorporated into the aneurysm. Presented here are the results (clinical and radiographic) of coil embolization in aneurysms of the ICA-posterior communicating artery junction, variably aided by stents. The primary focus is angiographic configurations that impact stent placement. From a prospective data repository, we retrieved records of 32 consecutive patients with 33 posterior communicating artery aneurysms, all of which were treated by stent-assisted coil embolization between June 2008 and August 2012. Outcomes were analyzed in terms of aneurysm configuration and clinical status. Stents were positioned entirely in the ICA (n = 26), from the ICA to the posterior communicating artery (n = 2), in the posterior communicating artery only (n = 3), and retrograde from the posterior communicating artery to the ICA terminus (n = 2). Procedure-related complications occurred in 3 patients (9.1%), but only 1 (3.0%) had mild neurologic sequelae (Glasgow Outcome Score 4). Using coil embolization, we achieved successful occlusion in 24 aneurysms (72.7%), and in 9 others, subtotal occlusion was conferred. During a mean follow-up of 15.7 ± 10.7 months, imaging of 27 aneurysms documented stable occlusion in 19 (70.4%), whereas angiography of 15 aneurysms (39.5%) disclosed 2 instances of in-stent stenosis (13.3%) and a solitary occurrence of stent migration (6.7%). In posterior communicating artery aneurysms, stent protection during coil embolization is feasible by adjusting the procedural strategy to accommodate differing configurations of the aneurysm and its vascular source.

Initial Experience with the New Double-lumen Scepter Balloon Catheter for Treatment of Wide-necked Aneurysms

ObjectiveA new double-lumen balloon catheter was being developed for the treatment of cerebral aneurysms. The purpose of this study is to report our initial experience of a double-lumen balloon catheter for the treatment of wide-necked aneurysms.Materials and MethodsSeventeen patients (mean age, 63 years; range, 45-80 years) with wide-necked, with or without a branch-incorporated aneurysms, (10 ruptured and 9 unruptured) were treated with balloon-assisted coil embolization using a double-lumen balloon catheter (Scepter C™ or Scepter XC™) for 7 months after being introduced to our country. Locations of the aneurysms were posterior communicating artery (n = 7), anterior communicating artery or A2 (n = 7), middle cerebral artery (MCA) bifurcation (n = 3), basilar artery tip (n = 1) and anterior choroidal artery (n = 1). The initial clinical and angiographic outcomes were retrospectively evaluated.ResultsCoil embolization was successfully completed in all 19 aneurysms, resulting in complete occlusions (n = 18) or residual neck (n = 1). In one procedure, a thrombus formation was detected at the neck portion of the ruptured MCA bifurcation aneurysm near to the end of the procedure. It was completely resolved with an intra-arterial infusion of Glycoprotein IIb/IIIa inhibitor (Tirofiban, 1.0 mg) without any clinical sequela. There were no treatment-related events in the remaining 18 aneurysms. At discharge, functional neurological state improved in 11 patients (10 patients with ruptured aneurysm and 1 with unruptured aneurysm presenting with mass symptoms) and 6 patients with unruptured aneurysms had no newly developed symptoms.ConclusionIn this preliminary case series, the newly developed double-lumen Scepter balloon appears to be a safe and convenient device for coil embolization of wide-necked aneurysms.

Coil embolization using the self-expandable closed-cell stent for intracranial saccular aneurysm: A single-center experience of 289 consecutive aneurysms

To present the clinical and radiological follow-up results of coil embolization using the Enterprise stent for intracranial saccular aneurysms. The clinical and morphological outcomes of 261 consecutive patients with a total of 289 aneurysms that were treated with a stent-protected coiling technique using the Enterprise stent from June 2008 to August 2011 were assessed. Stents were delivered before first coil insertion in 162 aneurysms (56.1%), during coiling in 68 (23.5%), and after completion of coil insertion in 59 (20.4%). Procedure-related complications occurred in 36 patients (13.8%), and four (1.5%) suffered permanent neurological sequelae. Successful occlusion after coil embolization was achieved in 205 aneurysms (70.9%) and subtotal occlusion was achieved in 84. During the mean follow-up of 12.4 (±5.8) months, follow-up imaging of 229 aneurysms (79.2%) documented stable occlusion in 183 (79.9%) of the lesions, minor recanalization in 17 (7.4%), and major recanalization in 29 (12.7%). Follow-up angiography of 110 aneurysms (38.1%) demonstrated in-stent stenosis in 14 (12.7%) and stent migration in five (4.5%). Eleven patients (4.2%) suffered late delayed infarction during the follow-up period, which was related to cessation or modification of anti-platelet medication. The stent-protection technique using the Enterprise stent is useful and effective for coil embolization of wide-necked aneurysms due to easy navigation and precise placement. However, the possibility of procedure-related complications, in-stent stenosis, and delayed cerebral infarction should be noted.

Endovascular Treatment of Wide-Neck Intracranial Aneurysms Using a Microcatheter Protective Technique: Results and Outcomes in 75 Aneurysms

The microcatheter protective technique positions an additional microcatheter in the parent or side-branching artery to protect it during coil embolization. The purpose of this study was to describe this method and to evaluate its efficacy and safety as an alternative to a multiple-microcatheter or balloon- or stent-assisted technique for wide-neck aneurysms. A retrospective review of 74 patients (43 women; mean age, 59.6 years) with 75 wide-neck aneurysms treated with the microcatheter protective technique between January 2003 and April 2010 was performed. Immediate postembolization angiograms were evaluated by using a conventional angiographic scale, and clinical evaluation was performed by using the GOS. Clinical and imaging follow-up were available in 57 (76%) patients, with a mean of 14.7 months. Postembolization angiograms demonstrated total occlusion in 45 of 75 (60%) aneurysms, a neck remnant in 17 (22.7%), and body filling in 13 (17.3%). The technique-related complication rate was 17.4% (13/75), and the procedural-related morbidity rate was 1.3% (1/74). All patients, except 3 complicated cases with a GOS of <4, had a GOS of 5 at the end of the study period. Of the 57 aneurysms with follow-up, recanalization developed in 5 (8.8%) aneurysms, and 3 (5.3%) cases of major recanalization were re-treated endovascularly. The microcatheter protective technique is feasible and safe for coil embolization of wide-neck aneurysms, especially in cases that are not suitable for multiple catheter or balloon- or stent-assisted techniques.

P-021 Endovascular treatment of wide necked intracranial aneurysms using microcatheter protective technique: techniques and outcomes in 71 aneurysms

IntroductionCatheter protective technique, an adjunctive technique of multiple microcatheter techniques, means positioning an additional microcatheter, instead of a balloon or stent, in the parent or side branching arteries to protect...

Shape Memory Polymer Stent With Expandable Foam: A New Concept for Endovascular Embolization of Fusiform Aneurysms

We demonstrate a new concept for endovascular embolization of nonnecked fusiform aneurysms. A device prototype consisting of a stent augmented with expandable foam, both made from shape memory polymer, was fabricated and deployed in an in vitro model. Visual observation indicated that the foam achieved embolization of the aneurysm while the stent maintained an open lumen in the parent artery. The shape memory polymer stent-foam device is a potential tool for treatment of nonnecked fusiform aneurysms, as well as an alternative to stent- and balloon-assisted coil embolization of wide-necked aneurysms.

Embolization of wide-necked aneurysms with using three or more microcatheters

A new and relatively simple endovascular technique, in which more than three microcatheters are used for endovascular treatment of cerebral aneurysms for the first time, is described. Eight patients with wide necked aneurysms were successfully treated with detachable coils using the multiple microcatheter technique. Three patients presented with subarachnoid haemorrhage and five were unruptured. The aneurysm locations were superior hypophyseal artery (2), posterior communicating artery (2), middle cerebral artery bifurcation (1), distal anterior cerebral artery (1), basilar artery (1) and vertebral artery (1). The average neck size was 7.4 +/- 2.8 mm (3.5-12 mm), average width of the aneurysms was 10.6 +/- 5.7 mm (6.2-23 mm) and depth was 8.9 +/- 5.8 mm (3-22 mm). Three microcatheters (7 patients) and four microcatheters (1 patient) were introduced and used for coil delivery. Three or four coils were deployed and intermingled to stabilize the whole coil mass as well as to occupy the aneurysmal sac. When a relatively stable coil frame was formed, one coil was detached and subsequent coils were inserted. After the coil mass became more stable, other coils were also detached and all microcatheters were used for subsequent coil deployment. All aneurysms were successfully treated without complications. Postemboilzation angiograms showed no contrast filling in 5 cases (100% occlusion) and a very small residual neck in 3 cases. There was no procedure related complication. The multiple microcatheter technique can be one technical option for the endovascular treatment of wide necked aneurysms.