Coil embolization of recurrent ruptured vertebral artery dissection through a marathon microcatheter: A case report

A 56-year-old healthy woman presented with subarachnoid hemorrhage caused by ruptured vertebral artery dissecting aneurysm and was treated with internal trapping of the affected site including the aneurysm. She suffered rebleeding due to recanalization of the aneurysm 5 days after the first treatment. Because of the close proximity of the coil mass to the posterior inferior cerebellar artery (PICA) origin at first treatment, additional coil embolization by tight packing of the coil mass was planned. However, navigation of the microcatheter into the coil mass was challenging due to the tightly packed coil mass. Thus, a Marathon microcatheter, which has narrower outer diameter and is designed for liquid embolization, was used and successfully placed into the coil mass in an anterograde fashion. Thereafter, the DAC was advanced just proximal to the coil mass to reduce the kickback of the microcatheter during deployment of the coils and avoid the coil mass expansion toward the PICA origin, resulting in complete obliteration of the aneurysm with PICA preservation. Follow-up angiography performed 6 months after the second treatment showed complete obliteration of the aneurysm. The patient's course was uneventful after 1 year following the second treatment, with a modified Rankin Scale score of 1. Therefore, coil embolization through the tightly packed coil mass using a Marathon microcatheter is feasible. A low-profile DAC is also useful for enabling physicians to push the coil deployed through the flexible Marathon microcatheter.