Acta Neurochirurgica

, Volume 156, Issue 5, pp 839–846 | Cite as

Coil embolization of overwide and undertall small intracranial aneurysms with double microcatheter technique

  • Dong Joon KimEmail author
  • Byung Moon Kim
  • Keun Young Park
  • Eun Hyun Ihm
  • Jang Hyun Baek
  • Dong Ik Kim
Clinical Article - Vascular



Overwide and undertall small intracranial aneurysms remain a challenge for coil embolization. The purpose of this study is to evaluate the feasibility and results of intrasaccular double microcatheter endovascular coil embolization of overwide and undertall small intracranial aneurysms.


Small (<7 mm), overwide (dome-to-neck ratio [DNR] ≤1.2), and undertall (ASPECT ratio ≤1.2) aneurysms which were treated with double microcatheter technique were selected. For the double microcatheter technique, two microcatheters were selected simultaneously into the aneurysm sac and coil insertion was performed alternatingly. The initial results, ASPECT, DNR ratios, complications, and follow-up results were assessed.


Twenty small (mean, 3.8 mm), overwide (mean DNR, 1.1), and undertall (mean ASPECT, 1.0) aneurysms were treated with the double microcatheter technique. Overall, complete or near complete occlusion was achieved in 19/20 cases. This was achieved with only the double microcatheter technique in 16/20 cases (ASPECT mean, 1.0; DNR mean, 1.1). Adjuvant balloon remodeling was performed in 4/20 cases (ASPECT mean, 0.8; DNR mean, 1.1). The ASPECT ratio was significantly lower in the adjuvant balloon remodeling cases (p = 0.027). Coiling failed in one patient with both DNR and ASPECT ratio <1.0. Overall, one patient developed a focal visual field defect after the procedure. No other patients developed neurologically significant complications.


Double microcatheter technique may be a safe and effective method for the treatment of overwide and undertall small intracranial aneurysms.


Aneurysm Coil Embolization Microcatheter 



This study was supported by a faculty research grant of Yonsei University College of Medicine for 2011 (6-2011-0080) and from the Korea Healthcare technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (A085136).

Conflict of Interest



  1. 1.
    Baxter BW, Rosso D, Lownie SP (1998) Double microcatheter technique for detachable coil treatment of large, wide-necked intracranial aneurysms. AJNR Am J Neuroradiol 19:1176–1178PubMedGoogle Scholar
  2. 2.
    Brinjikji W, Cloft HJ, Kallmes DF (2009) Difficult aneurysms for endovascular treatment: overwide or undertall? AJNR Am J Neuroradiol 30:1513–1517PubMedCrossRefGoogle Scholar
  3. 3.
    Bruening R, Mueller-Schunk S, Morhard D, Seelos KC, Brueckmann H, Schmid-Elsaesser R, Straube A, Mayer TE (2006) Intraprocedural thrombus formation during coil placement in ruptured intracranial aneurysms: treatment with systemic application of the glycoprotein IIb/IIIa antagonist tirofiban. AJNR Am J Neuroradiol 27:1326–1331PubMedGoogle Scholar
  4. 4.
    Cloft HJ (2006) HydroCoil for Endovascular Aneurysm Occlusion (HEAL) study: periprocedural results. AJNR Am J Neuroradiol 27:289–292PubMedGoogle Scholar
  5. 5.
    Cloft HJ, Joseph GJ, Tong FC, Goldstein JH, Dion JE (2000) Use of three-dimensional Guglielmi detachable coils in the treatment of wide-necked cerebral aneurysms. AJNR Am J Neuroradiol 21:1312–1314PubMedGoogle Scholar
  6. 6.
    Debrun GM, Aletich VA, Kehrli P, Misra M, Ausman JI, Charbel F (1998) Selection of cerebral aneurysms for treatment using Guglielmi detachable coils: the preliminary University of Illinois at Chicago experience. Neurosurgery 43:1281–1295, discussion 1296–1287PubMedGoogle Scholar
  7. 7.
    Kim DJ, Suh SH, Kim BM, Kim DI, Huh SK, Lee JW (2010) Hemorrhagic complications related to the stent-remodeled coil embolization of intracranial aneurysms. Neurosurgery 67:73–78, discussion 78–79PubMedCrossRefGoogle Scholar
  8. 8.
    Kim DJ, Suh SH, Lee JW, Kim BM, Huh SK, Kim DI (2010) Influences of stents on the outcome of coil embolized intracranial aneurysms: comparison between a stent-remodeled and non-remodeled treatment. Acta Neurochir (Wien) 152:423–429CrossRefGoogle Scholar
  9. 9.
    Kiyosue H, Tanoue S, Okahara M, Hori Y, Nakamura T, Nagatomi H, Mori H (2002) Anatomic features predictive of complete aneurysm occlusion can be determined with three-dimensional digital subtraction angiography. AJNR Am J Neuroradiol 23:1206–1213PubMedGoogle Scholar
  10. 10.
    Kwon OK, Kim SH, Kwon BJ, Kang HS, Kim JH, Oh CW, Han MH (2005) Endovascular treatment of wide-necked aneurysms by using two microcatheters: techniques and outcomes in 25 patients. AJNR Am J Neuroradiol 26:894–900PubMedGoogle Scholar
  11. 11.
    Lee YJ, Kim DJ, Suh SH, Lee SK, Kim J, Kim DI (2005) Stent-assisted coil embolization of intracranial wide-necked aneurysms. Neuroradiology 47:680–689PubMedCrossRefGoogle Scholar
  12. 12.
    Lim YC, Kim BM, Shin YS, Kim SY, Chung J (2008) Structural limitations of currently available microcatheters and coils for endovascular coiling of very small aneurysms. Neuroradiology 50:423–427PubMedCrossRefGoogle Scholar
  13. 13.
    Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274PubMedCrossRefGoogle Scholar
  14. 14.
    Morita A, Fujiwara S, Hashi K, Ohtsu H, Kirino T (2005) Risk of rupture associated with intact cerebral aneurysms in the Japanese population: a systematic review of the literature from Japan. J Neurosurg 102:601–606PubMedCrossRefGoogle Scholar
  15. 15.
    Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, Hashimoto N, Nakayama T, Sakai M, Teramoto A, Tominari S, Yoshimoto T (2012) The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366:2474–2482PubMedCrossRefGoogle Scholar
  16. 16.
    O’Kelly CJ, Spears J, Chow M, Wong J, Boulton M, Weill A, Willinsky RA, Kelly M, Marotta TR (2012) Canadian experience with the pipeline embolization device for repair of unruptured intracranial aneurysms. AJNR Am J Neuroradiol 34:381–387PubMedCrossRefGoogle Scholar
  17. 17.
    Pierot L, Cognard C, Spelle L, Moret J (2012) Safety and efficacy of balloon remodeling technique during endovascular treatment of intracranial aneurysms: critical review of the literature. AJNR Am J Neuroradiol 33:12–15PubMedCrossRefGoogle Scholar
  18. 18.
    Piotin M, Blanc R, Spelle L, Mounayer C, Piantino R, Schmidt PJ, Moret J (2010) Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke 41:110–115PubMedCrossRefGoogle Scholar
  19. 19.
    Sluzewski M, van Rooij WJ, Beute GN, Nijssen PC (2006) Balloon-assisted coil embolization of intracranial aneurysms: incidence, complications, and angiography results. J Neurosurg 105:396–399PubMedCrossRefGoogle Scholar
  20. 20.
    Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O’Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner JC (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110PubMedCrossRefGoogle Scholar
  21. 21.
    Yamada NK, Cross DT 3rd, Pilgram TK, Moran CJ, Derdeyn CP, Dacey RG Jr (2007) Effect of antiplatelet therapy on thromboembolic complications of elective coil embolization of cerebral aneurysms. AJNR Am J Neuroradiol 28:1778–1782PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Dong Joon Kim
    • 1
    • 3
    Email author
  • Byung Moon Kim
    • 1
  • Keun Young Park
    • 1
    • 2
  • Eun Hyun Ihm
    • 1
    • 2
  • Jang Hyun Baek
    • 1
  • Dong Ik Kim
    • 1
  1. 1.Department of RadiologyYonsei University College of MedicineSeoulKorea
  2. 2.Department of NeurosurgeryYonsei University College of MedicineSeoulKorea
  3. 3.Department of Radiology, Severance HospitalYonsei University College of MedicineSeoulSouth Korea

Personalised recommendations