＜Editors’ Choice＞ Initial experience with in vivo “endovascular shaping” technique that utilizes the vascular configuration for small cerebral aneurysm coiling

Optimal shaping of a microcatheter tip is a key factor in cerebral aneurysm coiling. However, safe cannulation and stabilization of a microcatheter can be technically challenging with small aneurysms requiring precise microcatheter shaping. We devised a new microcatheter shaping technique which bends a microcatheter tip in the intended direction by placing and keeping the tip in the selected branch of the parent artery for 5 minutes: endovascular shaping technique. Our method can complete microcatheter shaping only inside the patient’s body; an endovascularly shaped microcatheter will never face a straightening deformity and rotation problem associated with catheter reinsertion. The aim was to assess the feasibility and safety of endovascular shaping for small aneurysm coiling. Clinically, 10 consecutive challenging small terminal-type aneurysms (< 5 mm) treated with endovascular shaping were included. We retrospectively analyzed the newly acquired bend angle of a microcatheter tip after the shaping, the procedural success, and clinical outcomes. An artificial vascular model was used to confirm our findings. In all the 10 patients (three middle cerebral artery, four anterior communicating artery, and three basilar artery aneurysms), the endovascularly shaped microcatheters were bent toward the placement branch at an average of 21.7° and excellently guided into the aneurysms. Coil embolization was successfully accomplished without any complications. The results of the vascular model experiment demonstrated that an endovascularly shaped microcatheter acquired new bend angle toward the placement branch. Endovascular shaping was feasible and safe for small terminal-type aneurysm coiling. Our method can provide accurate shaping and stability during aneurysm coiling procedure.