Micro-catheter assisted coiling (MAC): A mid-path between simple and assisted coiling techniques in treating ruptured wide neck aneurysms and immediate post procedure outcomes

Background: Aneurysms with neck diameter >4 mm or dome to neck ratio <2 are wide-neck aneurysms. Balloons and stents are used to assist in coiling the wide-neck aneurysms, but these are associated with increased intra-procedure and peri-procedure risk in ruptured aneurysms. Microcatheter-assisted coiling (MAC) is an alternative salvage technique in these situations which is under reported. Materials and Methods: We describe our experience in a cohort of 16 patients with ruptured wide neck aneurysm treated with MAC technique. Our primary objective of intervention in acute setting was to secure the aneurysm to prevent rebleed. Results: Anterior communicating artery aneurysm was the most common (56.3%) followed by middle cerebral artery bifurcation aneurysm (18.8%), paraclinoid aneurysm (12.5%), posterior communicating artery aneurysm (6.3%) and basilar tip aneurysm (6.3%). Mean greatest dimension of dome and neck were 8.9 mm and 4.6 mm, respectively. Mean neck to dome ratio was 1.8. Fisher grade 3 and grade 4 subarachnoid haemorrhage (SAH) were observed in 56.3% and 43.7% patients, respectively. Immediate post-procedure digital subtraction angiography (DSA) showed Raymond Roy grade 1, grade 2 and grade 3 embolisation in 62.5%, 33.3% and 6.7% patients, respectively. No distal embolus, vessel occlusion, vessel perforation or aneurysm rupture was observed. Immediate post-procedure DSA showed good distal flow in all patients. Infarct was observed at 24 and 48 hours respectively, in two patients with Fisher Grade 3 SAH. Conclusion: Ruptured wide neck aneurysms can be embolised with complete preservation of branching vessel and distal flow. Total occlusion can be achieved in 2/3rd of patients.