Endovascular Treatment of Wide-Neck Intracranial Aneurysms Using a Microcatheter Protective Technique: Results and Outcomes in 75 Aneurysms

A 52-year-old female patient with a middle cerebral artery (M1) aneurysm. A, Right internal carotid angiogram shows a wide-neck aneurysm of the M1 segment. B, The aneurysmal configurations are visible in a 3D image (2.1 × 2.3 × 3.9 mm). C, A protective microcatheter is introduced into the anterior temporal branch along with the microwire. D, A coil-delivering microcatheter is positioned within the aneurysm. E, The first frame coil (Trufill Orbit Mini Complex 2 × 3 cm) is deployed via a coil-delivering microcatheter, and the anterior temporal branch is preserved. F, Although the first coil was fully deployed without coil protrusion into the parent artery, the first coil frame is still unstable. Therefore, the first coil remains undetached. To achieve coil stability with the second coil, an additional coil-delivering microcatheter is required. Accordingly, the protective microcatheter is retrieved, and it is repositioned into the aneurysmal sac to use as a coil-delivering microcatheter for the second coil. After that, a final coil (Axium Helical, ev3, Irvine, California; 1.5 × 2 cm) is deployed through the repositioned protective microcatheter by using a double-microcatheter technique. G, Completion angiogram obtained immediately after embolization shows total occlusion of the aneurysmal sac preserving the anterior temporal branch.