Objective: We report a new microcatheter shaping method that makes consistent and safe microcatheter navigation into cerebral aneurysms possible for coil embolization even in lesions difficult to catheterize.
Case Presentation: The patient was an 83-year-old woman who had been followed-up for unruptured aneurysm of the internal carotid-anterior choroidal bifurcation. Endovascular treatment was performed because a bleb tended to enlarge. A straight microcatheter was guided to the parent artery about 5 mm distal to the target aneurysmal neck. The whole catheter was pressed against the wall of the parent artery, and this state was maintained for about 3 minutes. When the catheter was retrieved out of the body, the 3D shape memorized by the catheter was in agreement with the 3D morphology of the parent artery on 3D-DSA. Two sites of the catheter were steam-shaped, and the catheter tip was further steam-shaped into a shape that is more likely to be stabilized in the aneurysm using a mandrel. The microcatheter could be guided into the aneurysm simply by pulling it from a point distal to the aneurysm. Satisfactory coiling could be achieved. The microcatheter could be guided into the aneurysm by simply pulling it from a point distal to the aneurysm in all five patients to whom this technique was applied (one patient with ruptured and four patients with unruptured aneurysms).
Conclusion: This method was extremely effective in not only aneurysms to which the microcatheter was difficult to guide, but also those in which advancing a Guidewire into the aneurysm in advance was dangerous.