Endovascular treatment of intracranial aneurysms has gained wide acceptance and, in many clinical situations, considered the first line therapy. Despite the technological advancements in the last 2 decades, significant challenges can be encountered with endovascular treatment. Factors such as tortuous proximal anatomy, small aneurysm size and unfavourable angle of aneurysm dome with respect to the parent vessel can present difficulty in safely accessing or occluding the aneurysm. Occasional difficulties also arise in accessing the aneurysm that has been previously treated with an intracranial stents. We report our initial experience with such, difficult to coil aneurysms using a newly introduced, low-profile Headway Duo microcatheter (Microvention Inc, Tustin, Ca).Materials and Methods
Ten aneurysms in 9 patients were embolised using Headway Duo micro-catheter. A 6F guide catheter was used in all cases. In nine aneurysms, primary coil embolisation was performed without the use of any adjunct devices. In one patient, an enterprise stent had been previously deployed across the aneurysm neck during stent assisted coil embolisation.Results
There were 9 patients (8 females) in this series with age ranging from 37–66 years (Mean 45.6 years). Five patients (6 aneurysms) were treated in the setting of acute sub-arachnoid haemorrhage (SAH) and four patients were treated electively. All 6 aneurysms in SAH patients were less than 4 mm in maximum diameter (range 1.4 mm-4 mm) and 3 of 6 aneurysms additionally had unfavourable angle with the parent vessel. Amongst the four elective aneurysms, 3 had been previously treated aneurysms with residual filling. These 3 aneurysms were considered difficult to access or treat using standard, 1.7 -1.8F micro-catheters. All cases in this series were technically successful. Seven of the 10 aneurysms were completely occluded, two had residual neck filling and one aneurysm had minimal residual aneurysm filling. In one patient with SAH from a 3 mm distal PICA aneurysm, a small intra-operative rupture occurred that was treated with further coil embolisation and heparin reversal. This was a clinically asymptomatic event. There were no permanent adverse events in this series.Conclusion
Our initial experience with Headway Duo micro-catheter for treatment of intracranial aneurysms is encouraging. It has the lowest profile (1.6 F) of currently available micro-catheters that accept the platinum micro-coils. A combination of low profile and hybrid coil/braid design allows superior navigation in tortuous anatomy. Lower distal profile presents an advantage when crossing a previously placed intracranial stent. We also found this microcatheter to be useful in accessing and treating small intracranial aneurysms, especially when the aneurysm dome subtended an unfavourable angle with the parent vessel. The limitations of this study include the bias inherent in retrospective series and a relatively small number of patients.Disclosures
D. Gandhi: 1; C; Arstasis Axera, Boston Scientific, NINDS. 2; C; Microvention, Covidian. T. Miller: None. N. Beaty: None. M. Fortes: 1; C; Arstasis, Axera Inc. J. Simard: None. E. Aldrich: None. G. Jindal: 1; C; Boston Scientific.