Coil embolization through the Marathon microcatheter: Advantages and pitfalls

Abstract

Due to technical limitations, small, distal, and tortuous intracranial pathology is sometimes out of reach of the current armamentarium of microcatheters designed for intracranial coil embolization. The Marathon microcatheter (Medtronic, Minneapolis, Minnesota, USA), designed specifically for the delivery of Onyx, is longer and more flexible than most coil delivery catheters. We report on nine patients (three with arteriovenous fistula, three with arteriovenous malformation, two with intracranial aneurysm, and one with tumor) where Marathon was used to deliver commercially available platinum coils. We also conducted laboratory compatibility testing and conclude that the Marathon can be used as a coil delivery catheter for Barricade coils (Blockade Medical, Irvine, California, USA) with diameter less than 0.012 in.

Keywords: Coil embolization; Marathon microcatheter; endovascular.

Figure 1.

Patient 52F with left distal posterior inferior cerebellar artery (PICA) branch aneurysm. (a) Magnified superselective angiogram of left PICA from Echelon-10 demonstrating aneurysm. Arrow indicates 90° turn into aneurysm. (b) Coil deployment via Marathon – note the lack of proximal marker. (c) Magnified superselective angiogram of aneurysm (arrow) post-coil embolization. (d) Six-week follow-up angiogram demonstrating continued aneurysm occlusion and patency of PICA.

Figure 2.

Patient 1F with Vein of Galen malformation. Marathon was selected due to the fragility of the neonatal feeders. (a) Magnified right internal carotid artery injection demonstrating previous coil masses and arteriovenous shunting. (b) Superselective catheterization of posterior choroidal artery with Marathon. (c) Coil deployment (followed by Onyx 34 delivery). (d) Post-treatment angiogram with improved shunting (arrow demonstrates coil and Onyx embolized posterior choroidal). There was no distal venous or lung embolization.

Figure 3.

Patient 29F with auricular arteriovenous malformation. Superselective angiogram of posterior auricular artery showing shunting to large venous varix. Note the arterial tortuosity.

Figure 4.

Patient 45M with large left facial arteriovenous malformation. (a) Left vertebral injection demonstrating arterio-venous shunting to the left jugular vein from the external carotid artery (ECA). Note the extreme tortuosity of the collateralized feeding vessels to the ECA fistula. (b) Catheterization of the ECA via the left vertebral artery with Marathon and deployment of coils into the internal maxillary artery and middle meningeal artery. (c) Post-embolization angiogram of the left internal carotid artery demonstrating reduction of the nidus.

Figure 5.

(a) Tortuous vessel model with Marathon catheter; (b) remaining pusher-wire of Barricade coil when fully deployed in Marathon catheter; (c) comparison with size of rotating hemostatic valve.