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

  • Clinical Article - Vascular
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Abstract

Background

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.

Methods

Small (<7 mm), 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.

Results

Twenty small (mean, 3.8 mm), 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.

Conclusions

Double microcatheter technique may be a safe and effective method for the treatment of overwide and undertall small intracranial aneurysms.

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Acknowledgments

This study was supported by a faculty research grant of Yonsei University College of Medicine for 2011 (6-2011-0080) and from the Korea Healthcare technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (A085136).

Conflict of Interest

None.

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Authors and Affiliations

  1. Department of Radiology, Yonsei University College of Medicine, Seoul, Korea

    Dong Joon Kim, Byung Moon Kim, Keun Young Park, Eun Hyun Ihm, Jang Hyun Baek & Dong Ik Kim

  2. Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea

    Keun Young Park & Eun Hyun Ihm

  3. Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea

    Dong Joon Kim

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  1. Dong Joon Kim
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  2. Byung Moon Kim
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  3. Keun Young Park
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  4. Eun Hyun Ihm
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  5. Jang Hyun Baek
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  6. Dong Ik Kim
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Corresponding author

Correspondence to Dong Joon Kim.

Additional information

Presented in part at the 2013 European Society of Neuroradiology Conference.

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Kim, D.J., Kim, B.M., Park, K.Y. et al. Coil embolization of overwide and undertall small intracranial aneurysms with double microcatheter technique. Acta Neurochir 156, 839–846 (2014). https://doi.org/10.1007/s00701-014-2049-1

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  • DOI: https://doi.org/10.1007/s00701-014-2049-1

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