Dual microcatheter technique for coil embolisation of irregular and wide-necked intracranial aneurysms: A case series

Background: The endovascular coiling of ruptured aneurysms with complicated geometry presents a significant treatment challenge, especially with the non-availability of adequate sized coils and balloon/stent. The dual microcatheter technique is an alternative treatment for stent-assisted coiling in acutely ruptured wide-necked aneurysms because of no antiplatelet therapy. Objective: We report our initial experience with the use of a dual microcatheter technique in seven patients. The technique provided an efficient strategy for treating aneurysms with complicated configurations and high risks. Patients and Methods: We describe a technique used to treat seven patients with irregular shaped and wide-necked aneurysms. In the initial attempts at embolisation, coil instability within the aneurysm or significant impingement of coil loops on the parent artery was observed. The advancement of a second microcatheter into the aneurysm allowed two coils to be braced across the aneurysmal neck before the detachment of either coil. This technique permitted successful coil treatment. Conclusion: The dual microcatheter technique is a safe and effective treatment for acutely ruptured wide-necked aneurysms due to few treatment-related complications and mortality rate.