title: Microcatheter Looping to Facilitate Aneurysm Selection in Coil Embolization of Paraclinoid Aneurysms.
abstract: OBJECTIVE
  Described herein is a microcatheter looping technique to facilitate aneurysm selection in paraclinoid aneurysms, which remains to be technically challenging due to the inherent complexity of regional anatomy.
  
  
  METHODS
  This retrospective study was approved by our Institutional Review Board, and informed consent was waived. Microcatheter looping method was employed in 59 patients with paraclinoid aneurysms between January 2012 and December 2013. In the described technique, construction of a microcatheter loop, which is steam-shaped or pre-shaped, based on the direction of aneurysms, is mandatory. The looped tip of microcatheter was advanced into distal internal carotid artery and positioned atop the target aneurysm. By steering the loop (via inner microguidewire) into the dome of aneurysm and easing tension on the microcatheter, the aneurysm was selected. Clinical and morphologic outcomes were assessed with emphasis on technical aspects of the treatment.
  
  
  RESULTS
  Through this looping technique, a total of 59 paraclinoid aneurysms were successfully treated. After aneurysm selection as described, single microcatheter technique (n = 25) was most commonly used to facilitate coiling, followed by balloon protection (n = 21), stent protection (n = 7), multiple microcatheters (n = 3), and stent/balloon combination (n = 3). Satisfactory aneurysmal occlusion was achieved through coil embolization in 44 lesions (74.6%). During follow-up of 53 patients (mean interval, 10.9 ± 5.9 months), only one instance (1.9%) of major recanalization was observed. There were no complications related to microcatheter looping.
  
  
  CONCLUSIONS
  This microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail.
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea.
authors.forename: Young Dae
authors.initials: YD
authors.lastname: Cho
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea.
authors.forename: Jong Kook
authors.initials: JK
authors.lastname: Rhim
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea.
authors.forename: Jeong Jin
authors.initials: JJ
authors.lastname: Park
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea.
authors.forename: Jin Sue
authors.initials: JS
authors.lastname: Jeon
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea.
authors.forename: Roh-Eul
authors.initials: RE
authors.lastname: Yoo
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea.
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Kang
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea.
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea.
authors.forename: Won-Sang
authors.initials: WS
authors.lastname: Cho
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea. ; Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea.
authors.forename: Moon Hee
authors.initials: MH
authors.lastname: Han
mesh_terms: D000328:Adult; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D002404:Catheterization / Q000379:methods; D002533:Cerebral Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents
keywords: Coil; Embolization; Looping; Microcatheter; Paraclinoid aneurysm