The Hairpin Hooking Method: A Practical Troubleshooting Maneuver for Branch Selection in Middle Meningeal Artery Embolization

Selective branch catheterization during middle meningeal artery (MMA) embolization often requires precise microguidewire (MGW) manipulation. During navigation, an MGW may buckle into a tight hairpin-shaped loop, impairing torque transmission and typically necessitating wire reshaping or exchange. We describe the Hairpin Hooking Method, a troubleshooting maneuver that utilizes this otherwise undesirable configuration to facilitate branch selection. When an MGW forms an intraluminal hairpin loop and enters a nontarget branch, the MGW is advanced further until the distal tip of the loop passes beyond the bifurcation while the microcatheter remains proximal. Gentle pull-back allows the hairpin tip to engage the orifice of the target branch, redirecting the MGW into the branch. Continued pull-back straightens the MGW, after which the microcatheter is advanced over the MGW. By utilizing the hairpin-shaped MGW configuration, this maneuver enables target-branch access without routine wire reshaping or exchange. The Hairpin Hooking Method is a simple and practical troubleshooting adjunct for selective branch catheterization during MMA embolization. By utilizing a hairpin-shaped MGW configuration, this technique enables controlled redirection into the target branch under appropriate anatomical conditions. Given its reliance on anatomical characteristics specific to dural arteries, this maneuver should be restricted to dural arteries such as the MMA and avoided in intradural vessels.