Although paraclinoid aneurysms do not exhibit a high risk of rupture, coil embolization is not always easy because of unstable microcatheter position. We present a technique that allows a stable microcatheter position for coil embolization of paraclinoid aneurysms.
We enrolled 34 consecutive patients who underwent coil embolization for paraclinoid aneurysms. A loop of distal microcatheter was shaped based on three-dimensional rotational angiography. The basic concept is to keep the proximal loop abutting the opposite wall of the aneurysm while using the distal loop for coiling. Then, a proximal curve was made to accommodate the shape of the carotid siphon, which may decide the direction of the loop. Stent-assisted coil embolization was performed in 19 wide-necked aneurysms. Immediate radiological outcomes were analyzed with Raymond classification and clinical outcomes were evaluated with modified Rankin Scale (mRS) scores.
Satisfactory occlusion of aneurysm was achieved in 94.1% (32/34) of patients with a Raymond score of 1 or 2. Packing density of ≥ 31% was achieved in 71% (24/34) of patients. No significant differences were observed between stent-assisted coiling and coiling-only groups. Follow-up magnetic resonance angiography and/or angiogram showed stable coil position, except in one patient with tiny recurrence (from Raymond scores 1 to 2) that did not require retreatment at the 6-month follow-up. mRS scores of 0–1 were obtained in all patients at 6 months.
Loop microcatheter technique allowed safe and stable coil packing for paraclinoid aneurysms. The same procedural concept is also being used for aneurysms in other vascular territories.
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This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2018R1A2B6003143). The sponsor had no role in the design or conduct of this research.
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained before procedure from all patients. The institutional review board in our institute approved this study.
The authors reported loop microcatheter technique for coil embolization of paraclinoid aneurysms. I believe that this kind of topics is often discussed in a clinical practice. However, it seemed to be seen in few instances on the scientific paper. Their shaping technique is based on angioarchitecture obtained by three-dimensional (3D) rotational angiography. This technique using new 3D modality is now standard and reasonable. They clearly demonstrated loop microcatheter technique with two ways. This might be a good example for the readers.
Okayama city, Japan.
This article is part of the Topical Collection on Vascular Neurosurgery Aneurysm
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Jia, Z.Y., Song, Y.S., Sheen, J.J. et al. Loop microcatheter technique for coil embolization of paraclinoid aneurysms. Acta Neurochir 160, 1755–1760 (2018). https://doi.org/10.1007/s00701-018-3642-5
- Microcatheter shaping