The combinational use of dual microcatheter technique and new hypersoft helical coil for endovascular treatment of tiny intracranial aneurysm with difficult geometry.

The endovascular coiling of very small ruptured aneurysms with difficult geometry presents a significant treatment challenge because of potential dangerous complications, such as intraprocedural ruptures. We report our initial experience with the use of a dual microcatheter technique, combined with new hypersoft helical coils, for the treatment of these difficult lesions. Fourteen very small aneurysms with a maximum diameter of ≤3 mm that presented difficult configurations, such as a wide neck or an important branch vessel arising from the fundus, were identified using digital subtraction angiography. These lesions were successfully treated using a dual microcatheter technique and new hypersoft helical coils. There were no intraprocedural ruptures or procedure-related thromboembolisms. Complete or near-complete occlusions were achieved in all of the lesions. A Raymond score of RS 1 was achieved in eight of the aneurysms (57.1%) and an RS 2 was achieved in six of the aneurysms (42.9%). The mean packing density was 35.5%. At the last post-procedure clinical follow-up, a good clinical outcome (a modified Rankin scale score of 0-2) was observed in 11 of the patients (91.7%). The result of angiographic follow up in 11 cases showed two recanalized aneurysms. The use of the dual microcatheter technique and new hypersoft helical coil allowed for stable coil framing and good packing in geometrically difficult tiny aneurysms and presented a low rate of adverse events related to the procedure. The technique provided an efficient strategy for treating very small aneurysms with difficult configurations and high risks.