The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago

Object. Reports in the literature have offered discussions of the feasibili ty, efficacy, and safety of balloon-assisted Guglielmi detachable coil (GDC ) placement in wide-necked intracranial aneurysms, which was first describe d by Jacques Moret as the "remodeling technique." In this article the autho rs summarize their results in a subset of aneurysms treated with GDCs using the remodeling technique. Methods. This report contains a retrospective analysis of 72 patients with 75 aneurysms who underwent 79 endovascular procedures performed using the r emodeling technique. Morphological outcome was determined at the end of eac h procedure and by reviewing available follow-up angiograms. Clinical asses sments and outcomes are reported using a modified Glasgow Outcome Scale. Coils were placed in 66 (88%) of 75 aneurysms selected for treatment. In ei ght aneurysms (11%) treatment failures occurred due to the tortuosity of th e vessel used to reach the aneurysms or because of balloon inadequacies. Incorporating all available follow-up data the authors found that 50 (78%) of 64 aneurysms were completely or subtotally (> 95%) occluded and eight (1 2%) of 64 were incompletely (< 95%) occluded. Since the time of coil placem ent, eight aneurysms have progressed to complete occlusion and another five have exhibited progressive thrombosis on followup angiograms. In three ane urysms there has been neck remnant growth. Surgical clipping was performed to treat six aneurysms after an initial coil placement procedure. Permanent incidences of morbidity were limited to four patients and there were three deaths directly related to the procedure. Conclusions. The remodeling technique shows promise in increasing the numbe r of cerebral aneurysms amenable to treatment by endovascular coil placemen t, and offers an alternative approach to aneurysms that have met with faile d surgical treatment or are surgically inaccessible. Long-term follow-up re view is needed to determine the final outcome of aneurysms treated by this technique.