Experience analysis of dual microcatheter technique for the endovascular treatment of intracranial ruptured aneurysms

Feng Wei; Zhang Feng; Zhang Xue; Shang Dongsheng; Hu Bingyu; Bao Yu; Wang Jun; Meng Xiangbin; Yi Mengqiu

doi:10.26939/j.cnki.CN11-9353/R.2025.07.012

Abstract：Objective To evaluate the clinical application value,technical nuances,efficacy and safety of the dual-microcatheter technique for the endovascular treatment of ruptured intracranial aneurysms,with a focus on ultra-early intervention.Methods A retrospective analysis was conducted on 36 patients with ruptured intracranial aneurysms treated with the dual-microcatheter coiling technique in our institution from August 2022 to August 2024.All procedures were performed in the ultra-early phase after rupture.The cohort included 13 males and 23 females,with a mean age of(56.35±8.16)years.Aneurysm locations were as follows:posterior communicating artery(16 cases),anterior communicating artery(12 cases),middle cerebral artery(4 cases),and other locations(4 cases).According to the Hunt-Hess scale,19 cases were grade Ⅰ,9 were grade Ⅱ,and 8 were grade Ⅲ.Technical details,immediate angiographic outcomes(assessed by the Raymond-Roy Occlusion Classification),periprocedural complications,clinical prognosis(evaluated by the modified Rankin Scale(mRS)),and follow-up results over 6-24 months were analyzed.Results The technical success rate was 100％.Immediate embolization results were Raymond-Roy Class Ⅰ in 30 cases(83.3％)and Ⅱ in 6 cases(16.7％),with no Class Ⅲ outcomes.Stent assistance was required in 8 cases(22.2％)with wide-neck aneurysm.No postoperative rebleeding or symptomatic large-territory cerebral infarction occurred.Asymptomatic small-sized infarctions were observed in 3 patients(8.3％),which resolved without neurological deficits after treatment.At the last follow-up,mRS scores were 0 in 28 cases(77.8％),1 in 6 cases(16.7％),and 2 in 2 cases(5.6％),and no patient had poor outcomes(mRS≥3).Aneurysm recurrence was noted in 3 cases(8.3％)during follow-up:one was treated with a flow-diverting stent,another received additional coiling,and the third was under continued observation.Conclusion The dual-microcatheter technique is a safe and effective treatment for ruptured intracranial aneurysms.Ultra-early intervention can effectively prevent rebleeding.Through meticulous intra-aneurysmal microcatheter positioning,strategic coil selection,and alternate packing,this technique can achieve a high rate of complete occlusion while avoiding or minimizing the need for stent placement,thereby improving patient prognosis.Meticulous attention to procedural details is paramount for enhancing the safety and efficacy of this technique.