• Jung Ho Ko, Jaewoo Chung, and Young-Joon Kim.
• Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea.
• World Neurosurg. 2020 Nov 1; 143: 553-556.

ObjectiveThe double microcatheter technique (DMT) is a common technique for treating intracranial aneurysms with endovascular coiling. The DMT is usually performed with 6 Fr guiding catheters. However, to the best of our knowledge, this technique using 5 Fr guiding catheters has not been reported. We report a DMT using a 5 Fr guiding catheter and the thoughts and tenets to make this possible.MethodsAn 84-year-old woman had presented with a subarachnoid hemorrhage caused by rupture of a broad-necked aneurysm on the origin of the left posterior inferior cerebellar artery. We decided to use the DMT for coil embolization. However, because of the tortuous and calcified vessels from the femoral artery to the vertebral artery (VA), placement of a 6 Fr guiding catheter within the left VA failed. Therefore, we changed the guiding catheter to a 5 Fr Chaperon guiding catheter, which has the largest inner diameter of the 5 Fr guiding catheters. It was successfully navigated to the left VA, and we performed the DMT using Headway Duo and Prowler 10 microcatheters. Coil embolization was successfully completed without any complications.ResultsDMT using a 5 Fr guiding catheter can be performed if the sum of the largest outer diameters of the 2 microcatheters is less than the inner diameter of the 5 Fr guiding catheter.ConclusionsThe DMT using a 5 Fr guiding catheter can be performed if the sum of the outer diameters of the 2 microcatheters is less than the inner diameter of the 5 Fr guiding catheter. This technique could be a safe and effective option for treatment of broad-necked aneurysms, especially in the case of an elderly patient with tortuous vasculature or posterior circulation.Copyright © 2020 Elsevier Inc. All rights reserved.

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