Dual Catheter Aneurysm Coiling

A useful and underutilized technique which, like many fine things in life, is an acquired taste.  Allows for more flexibility during coiling — interlocking coils, filling different compartments not otherwise easily accessible, maintaining access should one catheter fall out are some advantages.  Even in small aneurysms like this one.  Case courtesy Dr. Erez Nossek

Here is a small ruptured right MCA

Look at the proximal lobule/bubble.  The goal is to secure both lobes

In this case, it is important to deploy but not detach the lower / neck coil until the end. It serves as a backstop and becomes progressively enmeshed with dome coils, promoting overall stability.  Coiling is an art like any other…