title: Easy Advancement of a Large-Profile Microcatheter (Excelsior XT27™) by Parallel Use of Two Microguidewires For Stent Delivery.
abstract: OBJECTIVE
  In the endovascular treatment of cerebral aneurysms, navigating a large-bore microcatheter for delivery of an open-cell stent can be challenging, especially in wide-necked bifurcation aneurysms. We were able to overcome this difficulty by parallel use of two microguidewires through the stent-delivery microcatheter.
  
  
  METHODS
  From December 2014 to April 2015, we treated 15 patients with wide-necked bifurcation aneurysms. For stent delivery, we used a 300-cm 0.014-in microguidewire (Transend), which was placed into the target branch using an exchange technique. A 0.027-in microcatheter (Excelsior XT-27), which was designed for the stent, was advanced over the exchange microguidewire. If we had trouble in advancing the microcatheter over the exchange microguidewire, we inserted a regular microguidewire (Traxcess), into the microcatheter lumen in a parallel fashion. We also analyzed the mechanism underlying microcatheter positioning failure and the success rate of the 'parallel-wire technique'.
  
  
  RESULTS
  Among the 15 cases, we faced with navigation difficulty in five patients. In those five cases, we could advance the microcatheter successfully by applying the parallel-wire technique. There were no procedure-related complications.
  
  
  CONCLUSIONS
  Simply by using another microguidewire together with pre-existing microguidewire in a parallel fashion, the stent-delivery microcatheter can be easily navigated into the target location in case of any advancement difficulty.
authors.affiliation: Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Department of Neurology, Soetomo General Hospital/Airlangga University Hospital, Airlangga University Medical Faculty, Surabaya, Indonesia.
authors.forename: Yudhi
authors.initials: Y
authors.lastname: Adrianto
authors.affiliation: Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Ku Hyun
authors.initials: KH
authors.lastname: Yang
authors.affiliation: Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Hae-Won
authors.initials: HW
authors.lastname: Koo
authors.affiliation: Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Wonhyoung
authors.initials: W
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jung Cheol
authors.initials: JC
authors.lastname: Park
authors.affiliation: Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Deok Hee
authors.initials: DH
authors.lastname: Lee
keywords: Cerebral aneurysm; Intracranial stenting; Microcatheter; Microguidewire; Stent-assisted coiling