Balloon-assisted coil embolization of wide-necked aneurysms of the internal carotid artery: Medium-term angiographic and clinical follow-up in 22 patients

BACKGROUND AND PURPOSE: The management of broad-necked cerebral aneurysms b y Guglielmi detachable coils (GDCs) is technically challenging owing to a v ariety of factors, including difficulty in defining the aneurysm/parent ves sel interface angiographically and problems in achieving complete occlusion , later predisposing the aneurysm to regrowth/recanalization, We sought to determine whether the use of intraluminal balloons to remodel the parent ve ssel/aneurysm interface during GDC embolization would provide a safe means of improving the efficacy of endovascular treatment of broad-necked aneurys ms. METHODS: Twenty-two saccular aneurysms of the internal carotid artery were treated with GDCs by using balloon remodeling techniques. All aneurysms wer e characterized by wide necks or were small with unfavorable neck/fundus ra tios and required balloon assistance for coil embolization. Patients were f ollowed up both clinically and angiographically. RESULTS: By using a microcatheter-mounted nondetachable balloon to provide a temporary barrier across the aneurysmal neck, we were able to deploy GDCs safely within a variety of aneurysms. Among the 22 patients treated, aneur ysmal occlusion on follow-up angiography (mean, 19 months) was found in 17 of 20 patients (two patients died and no follow-up studies were available). Observed or suspected thromboembolic events occurred in four of 22 patient s, resulting in one permanent deficit. Twenty of the 22 patients had good t o excellent clinical outcomes. CONCLUSION: Although balloon-assisted coiling of cerebral aneurysms require s manipulation of a second microcatheter and an inflatable balloon, increas ing its technical complexity, we believe that this method has utility in tr eating broad-necked aneurysms and small aneurysms that are otherwise subopt imally managed by conventional GDC deployment.