Assisted Endovascular Coiling of Wide Neck Aneurysms - Double Microcatheter and JAIL Techniques

Introduction: Endovascular coiling of wide neck cerebral aneurysms is challengeable and bears a high risk of coil herniation or migration with parent artery thrombosis or distal thromboembolism. Advanced techniques for endovascular treatment of aneurysms with complex geometry has been developed, such as: stent-assisted coiling, balloon remodeling, double microcatheter and microcatheter branch protection techniques. Aim: Two of the current options for coil-embolisation of aneurysms with unfavorable aspect ratio (dome/neck) are presented. Material and Methods: A 43 years old woman in poor medical condition (Hunt & Hess grade 5) with ruptured aneurysm of the basilar artery bifurcation was treated using the “jail” technique for stent-assisted coiling. Another patient - 23 years old man, previously unsuccessfully treated in another institution, was presented to us with persistent headaches. Two coils were advanced simultaneously through two microcatheters to create stable basket and safely occlude the aneurysm. Results: Both aneurysms were completely occluded with no procedure related complications. The woman was discharged in stable condition and is constantly improving (modified Rankin Scale 4 on the first month exam). The other patient is asymptomatic and without complaints on the follow-up exams. Conclusion: The techniques we present are relatively easy to accomplish for an average experience vascular interventionalist and according to the literature data are not related to higher complication rates. Consequently we promote their use as a viable option for wide neck aneurysms coiling.