• Megumu Takata, Hitoshi Fukuda, Masanori Kinosada, Kosuke Miyake, and Kenichi Murao.
• Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan. Electronic address: mg707100@kuhp.kyoto-u.ac.jp.
• World Neurosurg. 2017 Sep 1; 105: 529-533.

BackgroundIn endovascular embolization of intracranial aneurysms, a tortuous cervical internal carotid artery can limit guiding catheter access to a sufficiently high position. Although intermediate distal access catheters can go beyond the tortuous segment of internal carotid arteries, they may increase the risk of procedure-related complications, require significantly complex technical procedures, and limit the use of adjunctive techniques. Using simple neck extension alone, we successfully improved guiding catheter access in 2 patients.MethodsThrough a provocative test, we confirmed suitability of manual neck extension in 2 patients with severe posterior curvature of a tortuous internal carotid artery. Intraoperatively, we manually extended the neck and stretched the curvatures. We guided a 6F guiding catheter superiorly and performed coil embolization with an occlusion balloon catheter in 1 case and with the balloon-assisted neck remodeling technique in 1 case.ResultsCoil embolization was completed without any adverse events in both cases.ConclusionsThe simple neck extension technique successfully improved accessibility of the guiding catheter. As the need for safe and highly skilled intervention increases, our technique may be useful because it can reduce procedure-related complications and allow balloon-assisted techniques.Copyright © 2017 Elsevier Inc. All rights reserved.

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