When Two Is Better than One : The Buddy-wire Technique in Flow-diversion Procedures

Area of Science:

• Interventional Neuroradiology
• Cerebrovascular Surgery
• Medical Device Technology

Background:

• Flow diverter (FD) delivery often requires large, stiff microcatheters, complicating intracranial navigation.
• The buddy-wire technique, using two microwires in one microcatheter, offers potential solutions for navigation and support challenges.

Purpose of the Study:

• To evaluate the utility and effectiveness of the buddy-wire technique in flow diverter procedures.
• To identify specific scenarios where the buddy-wire technique provides significant benefits.

Main Methods:

• Retrospective analysis of a prospectively collected database of flow diverter procedures.
• Inclusion of 208 consecutive patients treated with FDs between July 2014 and August 2020.
• Recording and statistical analysis of patient, anatomical, and procedural data, focusing on the 17 cases where the buddy-wire technique was employed.

Main Results:

• The buddy-wire technique was used in 17 out of 208 FD procedures (8.2%).
• In 14 patients with wide-necked aneurysms, the buddy-wire provided support, advanced the microcatheter, and mitigated the ledge effect.
• In two giant cavernous aneurysms, the buddy-wire facilitated re-entry into a foreshortened flow diverter.

Conclusions:

• The buddy-wire technique is a valuable adjunct in flow diverter procedures.
• It effectively prevents microcatheter herniation into aneurysm sacs.
• It mitigates the ledge effect in wide-necked aneurysms and aids re-entry into foreshortened devices.