• Michiyasu Fuga, Toshihiro Ishibashi, Issei Kan, Shunsuke Hataoka, Naoki Kato, Gota Nagayama, Tohru Sano, Hiroyuki Enomoto, Kazutaka Shirokane, Akihiko Teshigawara, and Yuichi Murayama.
• Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan. Electronic address: fugamichiyasu@icloud.com.
• World Neurosurg. 2024 Dec 24: 123592123592.

BackgroundSevere 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.MethodsWe 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.ResultsUltimately, 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.ConclusionsAlthough 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.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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