title: Microguidewire protection of wide-necked aneurysms incorporating orifices of tortuous acute-angled vessels: a novel approach.
abstract: BACKGROUND
  Protective/remodeling techniques for treating wide-necked intracranial aneurysms are constantly sought. However, their utility may be limited in lesions that incorporate the orifice of acute-angled efferent branch vessels. Furthermore, passage of a protective microcatheter may be challenging if a small branch is extremely tortuous. This study was conducted to explore a novel method of treating wide-necked aneurysms, utilizing microguidewire protection.
  
  
  METHODS
  A microcatheter is first passed into parent artery (proximal to aneurysm) to position a microguidewire proximally in the involved branch. A second microcatheter is then inserted into aneurysmal sac. Advancement of the first microcatheter forces the microguidewire to shift, thus covering aneurysmal neck. A framing coil may then be placed within aneurysmal sac, under microguidewire protection. After completing initial coil insertion, easing of tension on the microcatheter allows separation of protective microguidewire and frame coil, confirming stability of the initial coil.
  
  
  RESULTS
  This technique was applied to 11 intracranial saccular aneurysms of M1 segment (n=6), middle cerebral artery bifurcation (n=4), and anterior communicating artery (n=1) with success, combining stent protection in two patients. Coil embolization was thus facilitated, resulting in excellent outcomes for all patients. No morbidity or mortality was directly related to microguidewire protection.
  
  
  CONCLUSIONS
  Our small study suggests that microguidewire protection may be a safe alternative, if traditional remodeling or protective options are infeasible due to intrinsic vascular properties. This technique is particularly suited for treatment of wide-necked aneurysms where passage of protective microcatheters into involved branches is not achievable.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 28 Yongon-dong, Jongno-gu, Seoul, 110-744, South Korea.
authors.forename: Young Dae
authors.initials: YD
authors.lastname: Cho
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Kang
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Jun Hyong
authors.initials: JH
authors.lastname: Ahn
authors.forename: Seung Chai
authors.initials: SC
authors.lastname: Jung
authors.forename: Chang Hun
authors.initials: CH
authors.lastname: Kim
authors.forename: Moon Hee
authors.initials: MH
authors.lastname: Han
mesh_terms: D000368:Aged; D002408:Catheters, Indwelling; D002533:Cerebral Angiography / Q000295:instrumentation* / Q000379:methods; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D011474:Prosthesis Design; D015641:Radiography, Interventional / Q000295:instrumentation* / Q000379:methods
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