New embolization technique for intracranial vascular disease with the assistance of an Apollo microcatheter

Abstract

It is difficult to access small and remote intracranial vascular lesions when using routine coil-delivery microcatheters. A thin Apollo microcatheter can access these vascular lesions. The Apollo microcatheter is intended to reduce the risk of catheter entrapment during the deployment of Onyx due to the detachable tip; furthermore, the Apollo microcatheter with a 3 cm detachable tip has 2 markers. X-ray imaging revealed that the marker on the push lever of the coil matched the proximal marker on the Apollo microcatheter. Therefore, it can replace routine coil-delivery microcatheters to deliver certain coils and then cast Onyx following coiling. The technique has rarely been reported. Patient 1 was a 59-year-old male with a ruptured aneurysm at the branch of posterior cerebral artery. The aneurysm was coiled with a Jasper ®SS-10 coil via an Apollo microcatheter with a 3 cm detachable tip. Then, Onyx-18 was used to obliterate the aneurysm. The patient recovered well after the procedure. Patient 2 was a 51-year-old male with a brain arteriovenous malformation (BAVM). There was a fistulous structure in the nidus. The Apollo microcatheter with a 3 cm detachable tip was used to reach and coil the fistulous structure with a Jasper ®SS-10 coil. Then, Onyx-18 was used to partially embolize the BAVM. The patient recovered well after the procedure. Therefore, the use of an Apollo microcatheter with a 3 cm detachable tip to deliver both coils and Onyx represents a new approach for treating intracranial vascular diseases when routine coil-delivery microcatheters cannot reach the lesions.