A Novel Technique of Microcatheter Shaping using Real Image Display for Endovascular Aneurysmal Coil Embolization

In coil embolization of intracranial aneurysms, guiding the microcatheter to an appropriate site in the aneurysm and stabilizing it there are important. In paraclinoid internal carotid aneurysms, complicated three-dimensional (3-D) shaping of the microcatheter tip is occasionally required. We devised a novel shaping method for microcatheters by using a real image display (RID). The usefulness of this technique was validated. We used a RID consisting of a couple of concave mirrors. A piece of patient-specific vascular model, which was made using a 3-D printer before the operation, was set inside the RID. We obtained a real 3-D image just above the RID. As a microcatheter and its shaping inner mandrel could be entered in the hologram of the vasculature, we could create the actual shape of the microcatheter. The shaped microcatheter could be navigated at the desired position in the aneurysm. Complete obliteration of the aneurysm was achieved without any trouble among 30 consecutive cases. We evaluated the effectiveness of the RID for making and navigating a microcatheter in cases with challenging anatomies. It was useful for favorable microcatheter shaping, as the RID could be entered inside the aneurysm models, unlike when tracing the outer surface of rigid 3-D models.