title: Dual diagnostic catheter technique in the endovascular management of anterior communicating artery complex aneurysms.
abstract: BACKGROUND
  The configuration of the anterior communicating artery (AcomA) complex is important in the endovascular treatment of AcomA complex aneurysms. In cases of codominant anterior cerebral arteries (ACA), coil embolization may result in inadvertent occlusion of the contralateral ACA due to poor visualization. A second diagnostic catheter in the contralateral carotid artery may help with visualization of this angiographic blind spot. To our knowledge, the safety and efficacy of this dual diagnostic catheter technique have never been assessed.
  
  
  METHODS
  A cohort of consecutive patients that underwent coil embolization of an AcomA complex aneurysm at a major academic institution in the United States between 2007 and 2014 were retrospectively reviewed.
  
  
  RESULTS
  Eighty-two patients who had an AcomA complex aneurysm treated with coil embolization were identified. The dual diagnostic catheter technique was used in 17 (20.7%) patients. Aneurysms treated with the dual diagnostic catheter technique were less frequently ruptured and had less favorable dome-to-neck ratios as well as neck width for primary coil embolization. The rate of codominant ACAs was significantly higher and stent-assisted coil embolization was performed more frequently. The rate of thromboembolic complications, angiographic outcome, and retreatment did not differ between both the groups.
  
  
  CONCLUSIONS
  The dual diagnostic catheter technique is a safe and effective method during coil embolization of AcomA complex aneurysms and preferred for aneurysms with codominant ACAs, incorporation of either A1 or A2 segments into the aneurysm, and aneurysms with a wide neck and low dome-to-neck ratios.
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Fusco
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Lucy
authors.initials: L
authors.lastname: He
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Chua
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Sieber
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Abd A
authors.initials: AA
authors.lastname: Mazketly
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Arra S
authors.initials: AS
authors.lastname: Reddy
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ajith J
authors.initials: AJ
authors.lastname: Thomas
keywords: Aneurysm coiling; anterior communicating artery complex; stent-assisted coiling; subarachnoid hemorrhage