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Scaffolding Technique: A New Double-catheter Technique for Coil Embolization of Wide-necked Aneurysms

Objective: We herein report a new technique using double microcatheters to treat a wide-necked aneurysm in which the neck is incorporated with the parent artery. Case Presentations: Case 1: The patient was a 71-year-old woman with a large, wide-necked unruptured aneurysm of the basilar bifurcation area with the right posterior cerebral artery (PCA) incorporated in the aneurysm sac. We previously placed a scaffolding coil around the right PCA orifice via a microcatheter placed near the right PCA to avoid a framing coil via another microcatheter involving the right PCA orifice. After confirming that the framing coil did not obstruct the right PCA flow, the “scaffolding” coil was repositioned in the framing coil. Complete occlusion of the aneurysm was achieved with the stable frame of these two coils. Case 2: The patient was a 68-year-old woman who presented with subarachnoid hemorrhaging due to a ruptured aneurysm with a wide neck of the basilar bifurcation. Coiling with a conventional double-catheter technique failed to form suitable framing because the tips of both microcatheters faced the same direction (posterior) even after changing the shapes of the tips. After leading the tip of one microcatheter to face the anterior direction by inserting part of the first coil via the microcatheter, we placed the second coil via another microcatheter with its tip facing posteriorly. The second coil then came to functions as the scaffolding, holding the tip of the first catheter anteriorly. A stable frame was made when the remaining part of the first coil was deployed. Conclusion: We termed this method the “scaffolding technique.” This technique is an effective and safe option for treating wide-necked aneurysms.