Usefulness of "Double-catheter" Technique in GDC Treatment of Intracranial Wide-necked Aneurysm

Purpose: To describe two different methods of "double-catheter" techniques for the treatment of wide-necked intracranial aneurysms. MATERIALS AND METHODS: Using two microcatheters simultaneously, we treated two wide-necked ophthalmic aneurysms and one wide-necked basilar bifurcation aneurysm. In the two cases of ophthalmic aneurysms, the two microcatheters were placed in the aneurysm sac, thus allowing two coils to be braced across the aneurysmal neck before either was detached. In the case of the basilar bifurcation aneurysm, a microcatheter was placed in the posterior cerebral artery (PCA), and another within the aneurysm lumen. When making the first frame with a GDC, we tried to ensure that the frame of the coil and the microcatheter in the PCA did not over-lap. Then, through the microcatheter positioned at the PCA, angiography was performed and flow pattern and dye-disappearance time were evaluated. Subsequent coils were introduced, but in order to preserve PCA flow, not beyond the frame of the first coil. RESULTS: All three aneurysms were successfully embolized without parent artery compromise and the patients were discharged in good neurological condition. CONCLUSION: The "double-catheter" technique can provide a valuable option for treating wide-necked aneurysms, especially when 'balloon remodeling' is not feasible and/or the relationship between the aneurysmal neck and adjacent parent artery cannot be ascertained.