Treatment of Recurrent Aneurysm of the Internal Carotid Artery-poster Communicating Artery Using the Marathon Microcatheter: A Case Report

Abstract

We report the case of an aneurysm of the recurrent internal carotid artery (ICA)-posterior communicating artery (PCoA) treated using a liquid embolic delivery microcatheter (MC; Marathon). Case Presentation: A 66-year-old female previously presented with subarachnoid hemorrhage, which had been treated using coil embolization for a ruptured ICA-PCoA aneurysm. She was referred to our hospital because the aneurysm recurred 13 years after treatment. Angiography revealed a de novo lobulated aneurysm at the ICA-PCoA bifurcation with a relatively thickened PCoA branching from the neck of the aneurysm. We performed coil embolization after stent placement with the Neuroform Atlas in the range of the ICA terminus and the PCoA. However, the coils were unequally distributed and it was necessary to navigate the MC to the aneurysm within the stent through the PCoA. We successfully approached the aneurysm using the Marathon. We additionally inserted six ED coils into the aneurysm and achieved favorable embolization. Conclusion:The Marathon is useful for passage of a stent deployed in a small-caliber artery.

Coil Embolization of Unruptured Distal Anterior Cerebral Artery Aneurysm Using a Marathon Microcatheter

“…Only nine cases have been reported in which Marathon was used for coil embolization of aneurysms (Table 1 ) [ 1 - 5 ]. Becket et al reported that Marathon was useful for distal posterior inferior cerebellar artery aneurysms because of its small diameter and long effective length [ 1 ].…”

“…Sonobe et al reported that the small diameter of Marathon allowed the trans-cell technique to be used for ruptured case of intracavernous sinus carotid artery aneurysm after placement of a flow diverter [ 3 ]. Uyama et al reported that during stent-assisted coil embolization of the ICA-posterior communicating artery aneurysm, the small diameter of Marathon made it easier to pass through a stented posterior communicating artery and perform the trans-cell technique [ 5 ]. In our case, ACA diverged from the ICA at an acute angle, but Marathon was useful because it was able to successfully enter A1.…”

“…One is that the inner lumen at the tip is as small as 0.013 inch, and the coils that can be used are limited. In previous reports, ED extrasoft, ED infini extrasoft, Barricade (Blockade Medical, Irvine, CA, USA), and Target ultrasoft (Stryker Neurovascular, Fremont, CA, USA) were used for embolization of aneurysms, and good embolization was obtained in all cases (Table 1 ) [ 1 - 5 ]. However, due to its long effective length of 165 cm, the Y adapter must be temporarily removed when using the Barricade or Target, and irrigation in the Marathon will stop [ 1 , 2 ].…”

“…Although there are restrictions on the coils that can be used, sufficient embolization of aneurysms is possible even with Marathon. To date, only nine cases have been reported in which Marathon was used for coil embolization of aneurysm, but no reports have been used in coil embolization of distal anterior cerebral artery (ACA) aneurysms [ 1 - 5 ]. We have reported a successful case using Marathon in coil embolization in case of a distal ACA aneurysm.…”