Endovascular treatment of wide-neck intracranial aneurysms using a microcatheter protective technique: results and outcomes in 75 aneurysms

Abstract

Background and purpose: 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.

Materials and methods: 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.

Results: 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.

Conclusions: 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.

Fig 1.

A 51-year-old female patient with an unruptured aneurysm of the AcomA. A, Right internal carotid angiogram shows a wide-neck aneurysm of the AcomA. B, Clear aneurysmal configurations are seen in the 3D image (1.9 × 3.0 × 1.6 mm). C, A coil-delivering catheter is positioned within the aneurysm. Simultaneously, a protective microcatheter is introduced into the proximal segment of the ipsilateral A2. D, The first coil (Trufill Orbit Mini Complex, Cordis, 2 × 4 cm) is deployed via a coil-delivering microcatheter. A microwire remains in a protective microcatheter to apply higher tension to the frame coil. E, Angiogram obtained immediately after embolization shows total occlusion of the aneurysmal sac.

Fig 2.

A 52-year-old female patient with a middle cerebral artery (M1) aneurysm. A, Right internal carotid angiogram shows a wide-neck aneurysm of the M1 segment. B, The aneurysmal configurations are visible in a 3D image (2.1 × 2.3 × 3.9 mm). C, A protective microcatheter is introduced into the anterior temporal branch along with the microwire. D, A coil-delivering microcatheter is positioned within the aneurysm. E, The first frame coil (Trufill Orbit Mini Complex 2 × 3 cm) is deployed via a coil-delivering microcatheter, and the anterior temporal branch is preserved. F, Although the first coil was fully deployed without coil protrusion into the parent artery, the first coil frame is still unstable. Therefore, the first coil remains undetached. To achieve coil stability with the second coil, an additional coil-delivering microcatheter is required. Accordingly, the protective microcatheter is retrieved, and it is repositioned into the aneurysmal sac to use as a coil-delivering microcatheter for the second coil. After that, a final coil (Axium Helical, ev3, Irvine, California; 1.5 × 2 cm) is deployed through the repositioned protective microcatheter by using a double-microcatheter technique. G, Completion angiogram obtained immediately after embolization shows total occlusion of the aneurysmal sac preserving the anterior temporal branch.

Fig 3.

A 54-year-old male patient with a right anterior choroidal artery aneurysm. A, Right internal carotid angiogram shows a wide-neck aneurysm of the anterior choroidal artery. B, The aneurysmal configurations are visible in the 3D image (2.4 × 3.7 × 2.3 mm). C, A coil-delivering microcatheter is positioned within the aneurysm. A protective microcatheter is introduced into the hyperplastic anterior choroidal artery. D, The first frame coil (Trufill Orbit Mini Complex, 2.5 × 3.5 cm) is deployed via a coil-delivering microcatheter. The coil protrudes and partially compromises the anterior choroidal artery. E, A protective microcatheter applies tension to the frame coil. After deployment of 1 more coil (Axium Helical, 1.5 × 2 cm), a stable coil mass is achieved. F, Angiogram obtained immediately after embolization shows total occlusion of the aneurysmal sac with a preserved anterior choroidal artery.