A Novel Method for Super-selective Coil Embolization Using an Extremely Soft Bare Coil through a Liquid Embolic Delivery Microcatheter

Abstract

Endovascular coil embolization for intracranial aneurysms, arteriovenous malformations (AVMs), dural arteriovenous fistulas (AVFs), and hypervascular tumors are recognized as an effective adjunctive or curative treatment. In this setting, it is sometimes difficult to navigate a coil delivery microcatheter to the target point of a tiny, tortuous vessel. We herein present a case series of a novel method that enabled super-selective coil embolization using an extremely soft bare, electrodetachable coil (ED extrasoft® coil) through a liquid embolic delivery microcatheter (Marathon®). The Marathon® catheter was successfully placed at the target point of the tiny, tortuous vessel, and coil embolization was achieved in all 16 patients with 9 AVMs, 2 distal aneurysms, 2 AVFs, and 3 meningiomas. The primary ED extrasoft® coil and delivery wire have a very small radius, and the coil is rapidly detachable with an alarm notice from the generator even under Marathon® with one marker. We believe that this technique can provide safe and efficient embolization for selected patients.

Embolization of a peripheral cerebral aneurysm associated with intracranial major artery occlusion through a transdural anastomotic artery: Case report

“…Because ED coil has the finest delivery wire system, it can be delivered through a Marathon catheter. 15 Therefore, this coil is very useful for embolization using both coils and NBCA in distally located peripheral disease such as the aneurysm in this case. Although the handling of the microcatheter at the delicate collateral vessel needs sufficient attention to avoid vascular injury, endovascular embolization is a useful treatment for the deeply located cerebral aneurysm that developed at the collateral vessels with intracranial major artery occlusion.…”

“…The OA is usually highly tortuous, and it is quite difficult to advance a microcatheter to the distal part of the artery. But the recent development of endovascular devices such as the triple-coaxial system 13 and flow-guide catheters, 14,15 as well as the advancement of endovascular treatment technique, has enabled the occlusion of deep-seated peripheral aneurysms. Because ED coil has the finest delivery wire system, it can be delivered through a Marathon catheter.…”

Use of detachable coils without the need of a double marker microcatheter: Technical note

“…The tip of a microcatheter is hidden in the coil mass to make a dense coil mass, but ED coil is precisely positioned for detachment in such situation because it does not depend on the visibility of even distal tip of the microcatheter as well as the proximal marker. The fact that the ED coil is well applicable through Marathon catheter is already described by Horie et al .,[ 9 10 ] though it is not combined with Onyx infusion in their experiences. They used ED coil through Marathon catheter to treat vascular diseases of peripheral vessels such as AVM and dural arteriovenous fistulas (AVF) to block a feeder with coils alone or to reduce feeding flow before the NBCA injection from the same catheter.…”

Coil embolization through the Marathon microcatheter: Advantages and pitfalls

“…Recently, the delivery of platinum coil through the Marathon microcatheter (Medtronic, Minneapolis, Minnesota, USA), a 165 cm, 1.5 Fr catheter designed for Onyx delivery, was described. [4][5][6] Herein, we outline our experience utilizing the Marathon catheter with commercially available coils, highlighting the benefits and pitfalls. Furthermore, we demonstrate the specific limitations utilizing a model system, which may help direct future decision-making.…”

“…An additional consideration is the mismatch between microcatheter length and the length of the coil pusher wire. As others have found, 4,6 it is necessary to remove the rotating hemostatic valve (RHV) to utilize the detachment tool ( Figure 5). Without the RHV, it is not possible to maintain continuous flush, which may increase the chance of clot formation.…”