Neurointervention.  2014 Feb;9(1):39-44. 10.5469/neuroint.2014.9.1.39.

Aneurysm Coil Embolization Using a 1.5-Fr Distal Outer Diameter Microcatheter

• Stidd DA
• Lopes DK
• Chen M

• KMID: 1910773
• DOI: http://doi.org/10.5469/neuroint.2014.9.1.39

Abstract

The current assortment of microcatheters widely used for aneurysm coil embolization may not be well suited for several anatomic variants, including excessive vascular tortuosity and small aneurysms less than 3 mm. Longer microcatheters designed with a smaller caliber that can accommodate and deliver coils may be of use in these situations. This case series and literature review illustrates the advantages and limitations of the Marathon microcatheter (Covidien, Irvine, CA, USA) when used for coil embolization of cerebral aneurysms. Despite some technical compromises including the distal marker, length, and the risk of buckling, the Marathon microcatheter was able to adequately deliver coils to achieve satisfactory occlusion of cerebral aneurysms. We found unique advantages with regards to length and smaller distal outer diameter (OD). These results may serve as a guide for the further development of a microcatheter used for coil embolization that has the features of a smaller distal OD and longer length.

Keyword

Cerebral aneurysms; Coil embolization; Endovascular procedures; Microcatheter

MeSH Terms

Aneurysm*
Embolization, Therapeutic*
Endovascular Procedures
Intracranial Aneurysm

Figure

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  Fig. 1 Coil embolization of an ACoA aneurysm using a Marathon microcatheter. A. Selective catheterization of the 6 mm bilobed ACoA aneurysm from the left ICA with a Marathon microcatheter. B. Satisfactory aneurysm coil embolization using 32 cm of bare platinum coil with uniform distribution.

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  Fig. 2 Lateral arterial phase angiogram of a right ICA injection. A. 4 mm inferiorly directed ruptured ACoA aneurysm. B. Raymond I occlusion using 14 cm of bare platinum coil.

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  Fig. 3 Clot flushed from the first Marathon microcatheter removed during Case 2 after the coil was withdrawn from the microcatheter.

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  Fig. 4 Stent-assisted coil embolization of a right ICA terminus aneurysm. A. A surface reconstruction of 3D DSA data acquired from a right ICA injection. B. Fluoroscopic image of the coil embolization of the ICA aneurysm showing a Marathon microcatheter aneurysm catheterization through a Neuroform stent deployed from the ICA to the A1 segment. The 3-cm maker is visible on the pusher wire, but a corresponding 3-cm radioopaque marker is not present on the Marathon microcatheter. C. Raymond I occlusion of the ICA terminus aneurysm.

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  Fig. 5 Photograph showing only 5 cm of pusher wire extending from the RHV attached to the Marathon microcatheter from Case 3. The Target coil was fully deployed into the aneurysm, but there was not enough pusher wire left to attach the handheld electrolytic detachment device. The RHV had to be removed from the Marathon microcatheter first before the detachment device could be used to detach the coil into the aneurysm.

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