title: Coil embolization of overwide and undertall small intracranial aneurysms with double microcatheter technique.
abstract: BACKGROUND
  Overwide and undertall small intracranial aneurysms remain a challenge for coil embolization. The purpose of this study is to evaluate the feasibility and results of intrasaccular double microcatheter endovascular coil embolization of overwide and undertall small intracranial aneurysms.
  
  
  METHODS
  Small (<7 mm), overwide (dome-to-neck ratio [DNR] ≤1.2), and undertall (ASPECT ratio ≤1.2) aneurysms which were treated with double microcatheter technique were selected. For the double microcatheter technique, two microcatheters were selected simultaneously into the aneurysm sac and coil insertion was performed alternatingly. The initial results, ASPECT, DNR ratios, complications, and follow-up results were assessed.
  
  
  RESULTS
  Twenty small (mean, 3.8 mm), overwide (mean DNR, 1.1), and undertall (mean ASPECT, 1.0) aneurysms were treated with the double microcatheter technique. Overall, complete or near complete occlusion was achieved in 19/20 cases. This was achieved with only the double microcatheter technique in 16/20 cases (ASPECT mean, 1.0; DNR mean, 1.1). Adjuvant balloon remodeling was performed in 4/20 cases (ASPECT mean, 0.8; DNR mean, 1.1). The ASPECT ratio was significantly lower in the adjuvant balloon remodeling cases (p = 0.027). Coiling failed in one patient with both DNR and ASPECT ratio <1.0. Overall, one patient developed a focal visual field defect after the procedure. No other patients developed neurologically significant complications.
  
  
  CONCLUSIONS
  Double microcatheter technique may be a safe and effective method for the treatment of overwide and undertall small intracranial aneurysms.
authors.affiliation: Department of Radiology, Yonsei University College of Medicine, Seoul, Korea, djkimmd@yuhs.ac.
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.forename: Byung Moon
authors.initials: BM
authors.lastname: Kim
authors.forename: Keun Young
authors.initials: KY
authors.lastname: Park
authors.forename: Eun Hyun
authors.initials: EH
authors.lastname: Ihm
authors.forename: Jang Hyun
authors.initials: JH
authors.lastname: Baek
authors.forename: Dong Ik
authors.initials: DI
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D057785:Catheters; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome