Neurointervention.  2016 Mar;11(1):24-29. 10.5469/neuroint.2016.11.1.24.

Easy Advancement of a Large-Profile Microcatheter (Excelsior XT27(TM)) by Parallel Use of Two Microguidewires For Stent Delivery

• Adrianto Y
• Yang KH
• Koo HW
• Park W
• Park JC
• Lee DH

• KMID: 2155715
• DOI: http://doi.org/10.5469/neuroint.2016.11.1.24

Abstract

PURPOSE
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.
MATERIALS AND 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.
CONCLUSION
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.

Keyword

Cerebral aneurysm; Stent-assisted coiling; Intracranial stenting; Microcatheter; Microguidewire

MeSH Terms

Aneurysm
Humans
Intracranial Aneurysm
Stents*

Figure

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  Fig. 1 Schema of a typical basilar bifurcation aneurysm. A. The microguidewire successfully placed using an exchange technique; however, the tip of the stent-delivery microcatheter failed to pass beyond the aneurysm neck because of the block caused by the gap between the microcatheter lumen and the microguidewire. B. Insertion of an additional microguidewire minimized the gap, after which the microcatheter is ready to advance into the target branch vessel.

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  Fig. 2 A 72-year-old woman presented with headaches due to a very wide-necked basilar bifurcation aneurysm. A. The aneurysm was located at the proximal portion of the left posterior cerebral artery and was closely associated with the ipsi-lateral superior cerebellar artery. B. Stent-assisted coiling was planned; however, the stent-delivery microcatheter (Excelsior XT27) was blocked due to the bump-like transition between the aneurysm neck and the parent artery branch (black arrow, video clip 1). C. The microcatheter could successfully advance into the target vessel by parallel insertion of another microguidewire (video clip 2). D. Coils were successfully packed in the sac under stent assistance.

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