Abstract 145: Successful Outcomes with the Triple microcatheter Technique for Aneurysmal Subarachnoid Hemorrhage

• Published in: Stroke: vascular and interventional neurology Vol. 4; no. S1
• Main Authors: Suppakitjanusant, P, Bushnaq, S, D Quispe‐Orozco, Vijil Mejia, M E, Qussous, J, Windisch, T
• Format: Journal Article
• Language: English
• Published: Phoenix Wiley Subscription Services, Inc 01-11-2024
• Subjects: Aneurysms; Embolization; Hemorrhage; Hypertension; Thromboembolism
• ISSN: 2694-5746; 2694-5746
• DOI: 10.1161/SVIN.04.suppl_1.145

IntroductionEndovascular coiling is a procedure used to manage intracranial aneurysms by inducing dense packing and rapid clot formation within the aneurysmal sac. This effectively isolates the aneurysm from blood flow, thereby preventing rupture. The dual microcatheter technique is often employed for wide‐necked aneurysms or those with an unfavorable dome‐to‐neck ratio. However, this method can be technically demanding, with risks such as coil herniation into the parent artery, potentially leading to thromboembolic complications or vessel occlusion.MethodsA case report involving the triple microcatheter coil embolization technique. Informed consent was obtained.ResultsA 55‐year‐old male with hypertension presented with confusion, left monocular visual loss, severe headaches, and nausea over the past three days. Examination revealed significant hypertension, a Glasgow Coma Scale score of 14, and a Hunt‐Hess grade of 3. CT head without contrast showed a large amount of subarachnoid hemorrhage in the basal cisterns, modified Fisher grade of 3. No midline shift. Digital subtraction angiography (DSA) was performed and identified a bilobed, broad‐necked basilar apex aneurysm with lobes measuring approximately 2.5 mm and 3 mm, projecting cranially. The aneurysm neck was 3.8 mm resulting in a very unfavorable dome‐to‐neck ratio (Figure 1). Three microcatheters were placed in the aneurysm sac, enabling stable coil deployment without thrombotic or embolic complications. Total fluoroscopy time was 15.6 minutes. Postoperatively, the patient received a low‐dose heparin drip to prevent delayed cerebral ischemia and nimodipine for 21 days. Three days later, he experienced cerebral vasospasm in the left internal carotid artery, which was managed successfully with selective intra‐arterial verapamil infusion. The patient showed clinical improvement with some right‐sided weakness before being discharged to a skilled nursing facility. At the one‐month follow‐up, his right hemiparesis and aphasia had significantly improved compared to his condition during hospitalization. A CT scan demonstrated complete resolution of the subarachnoid hemorrhage with no evidence of delayed hydrocephalus.ConclusionThe triple microcatheter coil embolization technique enhances stability and precision in managing complex ruptured aneurysms by reducing the risk of coil herniation and migration and promoting coil entanglement. Despite minimizing thromboembolic complications, the technique requires high technical skill and longer procedure times. Careful planning and expert execution tailored to the patient's anatomy are essential for achieving optimal outcomes.