Aneurysm Coil Embolization Using a 1.5-Fr Distal Outer Diameter Microcatheter
A 48-year-old man was admitted with a severe headache and subarachnoid hemorrhage in the suprasellar cistern, interhemispheric f issure, and bilateral sylvian fissures. He was found to have a 5 mm bilobed, inferiorly directed ACoA aneurysm (). Using a 6-Fr Neuron guide catheter, access was obtained to the right cervical ICA. A Marathon microcatheter was advanced over a Synchro 10 guidewire to selectively catheterize the aneurysm. Upon withdrawal of the wire, there was some movement of the microcatheter tip that required adjustment of forward tension on the microcatheter. Coil embolization with a 3 mm × 6 cm and 3 mm × 4 cm Barricade coils proceeded with caution. As in the previous case, the RHV and hence continuous flush had to be removed to accommodate the complete deployment of the coils. The lack of a 3 cm distal marker on the Marathon microcatheter prolonged the detachment times since caution was necessary to avoid advancing the pusher wire out of the distal microcatheter tip. Upon placement of a third 2 mm × 4 cm coil, there appeared to be increased resistance within the microcatheter causing buckling of the microcatheter near the carotid siphon. This was presumably because of clot collecting within the microcatheter. The microcatheter was removed, and after straightening out the catheter, the undetached coil was retrieved. The microcatheter was flushed on the back table, and clot emerged from the microcathter (). Another Marathon microcatheter was then advanced into the aneurysm and coil embolization was completed without complication (). The patient tolerated the procedure well and was discharged home after an uneventful hospital stay with a normal neurologic examination.