Feasibility and Safety of Double-Wire Technique for Microcatheter Navigation Beyond Tortuous Internal Carotid Siphon: A Propensity Score-Matched Study

• Published in: World neurosurgery 2025-01, Vol.194, p.123592, Article 123592
• Main Authors: Fuga, Michiyasu, Ishibashi, Toshihiro, Kan, Issei, Hataoka, Shunsuke, Kato, Naoki, Nagayama, Gota, Sano, Tohru, Enomoto, Hiroyuki, Shirokane, Kazutaka, Teshigawara, Akihiko, Murayama, Yuichi
• Format: Article
• Language: English
• Subjects: Buddy wire; Double microguidewire; Intrasaccular device; Ledge effect; Tortuous artery; Tortuous vessel
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.123592

Severe vessel tortuosity may prevent a microcatheter from reaching a distal vessel. However, the double-wire technique (DWT) may facilitate the procedure. The present study evaluated the feasibility and safety of guiding a 0.027-inch microcatheter into a distal vessel beyond the tortuous internal carotid siphon (ICS) using the DWT. We retrospectively reviewed 61 consecutive unruptured anterior circulation aneurysms in 61 patients who underwent treatment using flow diverter or intrasaccular flow disruption with a 0.027-inch microcatheter at our institution between October 2021 and August 2024. The DWT was used for patients in whom difficulties were encountered in advancing the microcatheter beyond the ICS with a single wire. Patients were divided into 2 groups, those who required the DWT (DWT group) and those who did not (non-DWT group). To investigate whether DWT use was associated with the degree of tortuosity of the ICS, a propensity score-matched analysis was used to control for background factors. Ultimately, 11 (18.0%) used DWT to guide a 0.027-inch microcatheter into the distal vessel of the ICS, achieving 100% success rate. After matching, the radius of ICS was significantly smaller in the DWT group than in the non-DWT group (2.7 mm vs. 3.7 mm, P = 0.039). No significant difference in the complication rate was found between the 2 groups. Although a 0.027-inch microcatheter is difficult to guide beyond a tortuous ICS to a distal internal carotid artery using only a single wire, the application of the DWT may allow the catheter to be guided without increased complications.