Unlike conventional coil embolization, aneurysm occlusion with PED is not immediate. Early complications include both thromboembolic and hemorrhagic events and appear to be significantly more frequent in association with treatment of vertebrobasilar aneurysms.

The prevalence of bilateral transverse sinus stenosis in the general population is not trivial. These data may be used as a reference for understanding the mechanistic role of stenoses in idiopathic intracranial hypertension, tinnitus, and refractory headaches.

BACKGROUND AND PURPOSE:Blister aneurysms of the supraclinoid ICA represent a rare but welldocumented cause of subarachnoid hemorrhage. These aneurysms are difficult to detect, and their surgical treatment is challenging, with high morbidity and mortality rates. The reports currently in the literature that describe the surgical and endovascular treatment of these aneurysms offer no clear consensus on the optimal treatment. We describe a staged endovascular treatment entailing stenting using a stent-in-stent technique, as well as planned but delayed embolization as the aneurysm increases in size to allow the introduction of coils.

Our results suggest that ophthalmic artery aneurysms may be adequately and safely treated with either the PED or coil embolization. However, treatment with the PED carries a higher risk of impeding flow to the ophthalmic artery, although this did not result in clinical sequelae in the current study.

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The PED may be used successfully to treat select aneurysms of the PICA. We present the first described cases of successful PED treatment of PICA aneurysms with direct placement of the PED in the PICA vessel itself. The proposed classification system aids in that selection.

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Object. The endovascular treatment of wide-necked aneurysms can be technically challenging due to distal coil migration or impingement of the parent vessel. In this paper, the authors illustrate an alternative method for the treatment of wide-necked intracranial aneurysms using a dual microcatheter technique.Methods. The authors' first 100 consecutive patients who underwent coil embolization of a wide-necked aneurysm using a dual microcatheter technique are reported. With this technique, 2 microcatheters are used to introduce coils into the aneurysm. The coils are deployed either sequentially or concurrently to form a stable construct and prevent coil herniation or migration. Angiographic and clinical outcomes are reported.Results. The technical success rate of the dual microcatheter technique is 91% with a morbidity and mortality of 1% and 2%, respectively. Clinical outcomes are excellent with 93% of patients demonstrating a modified Rankin Scale score of 0-2 at long-term follow-up regardless of their score at presentation. Retreatment rates are 18%.Conclusions. The dual microcatheter technique may be a safe and efficacious first line of treatment for widenecked aneurysms.(http: //thejns.org/doi/abs/10.3171/2014.7.JNS132237) key WorDs • dual • microcatheter • wide-necked • aneurysm • outcomes • vascular disorders • interventional neurosurgeryAbbreviation used in this paper: mRS = modified Rankin Scale. * Drs. Durst and Starke contributed equally to this work. C. R. Durst et al. 1094J Neurosurg / Volume 121 / November 2014 Patient SelectionA wide-necked aneurysm was defined as one having a dome-to-neck ratio of less than 2 or a neck diameter greater than 4 mm. 8,11,14,19 During the evaluated period, true saccular aneurysms were treated using this technique, but dissecting or blister aneurysms were not. Interventional ProcedureAccess to the femoral artery is obtained in a standard fashion. The guiding catheter must be able to simultaneously accommodate 2 microcatheters. The microcatheters can be either preshaped or steam-shaped to improve navigability and stability. The first microcatheter is advanced over a microguidewire into the aneurysm under roadmap guidance. At this point, attempts may be made to coil the aneurysm using a single microcatheter. Once it is determined that the dual microcatheter technique will be needed, a second microcatheter is introduced and advanced into the aneurysm. To prevent inadvertent manipulation, the microcatheter that is not in use is covered with a towel. The second microcatheter is usually steam shaped with a curve different from that of the first catheter so that the 2 microcatheters will occupy different parts of the aneurysm. Care must be taken when positioning the second microcatheter, as it can cause the first microcatheter to migrate forward.Two different general strategies can be described: "interleaving" and "locking."Interleaving Technique. This technique is most often used in particularly wide-necked aneurysms. In such aneurysms it may not be possible to place the ...