Abstract
INTRODUCTION AND IMPORTANCE: The twig-like middle cerebral artery (MCA) is rare and has a plexiform network of small vessels that replaces the MCA trunk, with a prevalence ranging from 0.11 %-1.17 %. It can be associated with an aneurysm. A Marathon microcatheter may be an alternative for coiling procedures. However, this technique has rarely been reported. PRESENTATION OF CASE: A 63-year-old man suffered from headaches. The neurological examination results were unremarkable. Angiography revealed a twig-like MCA with an unruptured aneurysm. Due to stenosis of the aneurysm neck, a Marathon microcatheter was used to successfully reach the aneurysm, and coiling was completed with Chinese Visee coils. Postoperatively, the patient recovered uneventfully. Due to the lack of ischemic changes in the right hemisphere, the patient was kept under follow-up observation. At the 8-month follow-up by telephone, the patient was healthy. CLINICAL DISCUSSION: Aneurysms in the twig-like MCA may have stenosis of the aneurysm neck, and routine microcatheters used to deliver coils are often too thick to catheterize the aneurysm neck. The Marathon microcatheter has a distal inner diameter (ID) of 0.013, and as an alternative for coiling procedures, it may be soft enough to thin enough to go into the aneurysm. However, it can be used in the delivery of certain coils. CONCLUSION: Aneurysms in the twig-like MCA are difficult to catheterize with the routine microcatheters used to deliver coils. A Marathon microcatheter may be used to perform the coiling procedure. However, only certain coils that match the Marathon microcatheter can be chosen.