title: Double microcatheter technique for coil embolization of small aneurysms with unfavorable configurations: A comparative study of the aneurysms that are ≤3 mm or >3 mm.
abstract: BACKGROUND
  The endovascular coiling of small ruptured aneurysms with difficult geometries presents a significant treatment challenge. We report our initial experience and the technical details of dual microcatheter coil embolizations that were applied in these difficult lesions.
  
  
  RESULTS
  Eighty-five small aneurysms (<7 mm) that exhibited difficult configurations, such as a wide neck or an important branch vessel arising from the fundus, were successfully treated using a dual microcatheter technique. The packing attenuation, adverse events during the procedures, and angiographic occlusions from 21 very small aneurysm (≤3 mm) were recorded and compared with our coiling results of 64 small aneurysms (>3 mm, <7 mm). There were no significant differences in intraprocedural ruptures or procedure-related thromboembolisms between the two groups. At the last post-procedure clinical follow-up, a good clinical outcome (an modified Rankin Scale (mRS) of 0-2) was observed in 18 of the patients (85.7%). The recanalization rates at follow-up were significantly lower in the very small aneurysm group compared to the small aneurysm group (p < 0.05) and the mean packing density in the very small aneurysm group was significantly higher compared to the small aneurysm group (35.2% vs 24.8%, p < 0.05).
  
  
  CONCLUSIONS
  The dual technique was feasible, safe, and effective for coil embolization of aneurysms with difficult configurations and, in particular, it provided an alternative option for treating very small aneurysms.
authors.affiliation: Department of Neurosurgery, Tianjin Huanhu Hospital, China.
authors.forename: Long
authors.initials: L
authors.lastname: Yin
authors.affiliation: Department of Neurosurgery, Tianjin Huanhu Hospital, China Department of Neurosurgery, The Second Hospital of Tianjin Medical University, China drweiming@163.com.
authors.forename: Ming
authors.initials: M
authors.lastname: Wei
authors.affiliation: Department of Neurosurgery, Tianjin Huanhu Hospital, China.
authors.forename: Hecheng
authors.initials: H
authors.lastname: Ren
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000473:pathology / Q000628:therapy; D001807:Blood Vessel Prosthesis; D057785:Catheters; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
keywords: Aneurysms; double microcatheter; embolization; endovascular treatment