Abstract
Objective: Obtaining a clear working projection image (WPI) is mandatory for secure and effective embolization of a cerebral aneurysm. However, there are some cases where contrast medium injection through a guiding catheter (GC) does not provide an optimal WPI due to overlapping of the arteries. Here, we report a case of an anterior communicating artery aneurysm which was successfully treated by modifying double microcatheter technique (DMT) in order to obtain an optimal WPI.
Case presentation: A 79-year-old woman was admitted to our hospital due to subarachnoid hemorrhage from an anterior communicating artery aneurysm. CTA revealed that the right A1 was too thin to be detected and that the aneurysmal neck was wide enough to involve both A2. Thus, an optimal working projection (WP) was to clarify relationship between both the A2 and the aneurysmal neck. Nevertheless, contrast medium injection through the guiding catheter at the WP provided an overlapping image of the aneurysm and the left internal carotid artery. Therefore, we introduced DMT to place one microcatheter (MC) at A1 to obtain an optimal WPI. The MC was further used for frame coil and kept holding the frame coil until the last filling coil was detached. In addition, another MC was first used to affirm the frame conformation, and then to fill coils. Preservation of the frame coil outline was confirmed by blank roadmap method during the procedure.
Conclusion: When a guiding catheter does not provide an optimal WPI, our modified DMT could be a choice.
