RECONSTRUCTION TECHNIQUE FOR WIDE NECK IN TRACRANIAL ANEURYSMS - LONG-TERM ANGIOGRAPHIC AND CLINICAL-RESULTS IN A SERIES OF 56 CASES

Purpose: The main factor limiting endovascular treatment of intracrani al aneurysms is the shape of the aneurysmal sac, particularly the widt h of the neck. in this study we present a new technique to occlude wid e neck aneurysms that involves the temporary inflation of a non-detach able balloon in front of the aneurysm neck during each coil placement. The aim of the study is to present the feasibility, efficacy and safe ty of this <<remodeling technique>> (RT) as compared to that of <<norm al>> GDC treatment. Material and method: 56 aneurysms in 54 patients w ere selected for treatment with the RT. Thirty-seven (70%) of the pati ents presented with subarachnoid hemorrhage. Twenty-five (45%) of the aneurysms were located at the vertebrobasilar artery, 24 (43%) at the internal carotid artery, and seven at the level of smaller arteries. R esults: Treatment was achieved in 52 aneurysms in 50 patients. Two ane urysms which were initially not completely occluded underwent a second treatment using the RT. Final results (i.e. the last follow-up angiog raphy or results at the end of the treatment for the cases that have n ot yet had follow-up) consisted of total occlusion in 40 cases (77%), subtotal occlusion in nine cases (17%), and incomplete occlusion in th ree cases (6%). Angiographic evidence of clotting was observed during the procedure in three cases, resulting in one permanent deficit (quad ranopia). Rupture of the aneurysmal sac occurred during the procedure in three cases, all of which were asymptomatic in the follow-up. Thus, morbidity due to the technique was 1/52 (0,5%) and mortality was 0/56 patients. Conclusion: The remodeling technique allowed the treatment of 52 wide neck or badly shaped aneurysms that were not treatable with out this technique. The results of occlusion with the RT seem better t han those in our series of normal GDC treatment, and complications rel ated to the technique are fewer. This technique thereby extends the sp ectrum of treatable aneurysms without increasing the risk incurred by treatment.