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

Background: 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.

Methods: 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 utilized for patients in whom difficulties were encountered in advancing the microcatheter beyond the ICS with a single wire. Patients were divided into two 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.

Results: 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 two groups.

Conclusions: Although a 0.027-inch microcatheter is difficult to guide beyond a tortuous ICS to a distal ICA using only a single wire, the application of the DWT may allow the catheter to be guided without increased complications.