Utility of balloon-assisted Guglielmi detachable coiling in the treatment of 49 cerebral aneurysms: a retrospective, multicenter study

Abstract

Background and purpose: The management of wide-necked aneurysms or aneurysms with a neck-to-body ratio close to 1 is a difficult challenge for the interventional radiologist because of the risk of coil migration or coil protrusion into the parent vessel. Our objective was to evaluate the efficacy and safety of balloon-assisted coiling as well as the follow-up results of occlusion for those difficult aneurysms in which conventional treatment with Guglielmi detachable coils (GDCs) had failed.

Methods: A nondetachable balloon was used in 49 procedures performed in 44 patients (35 women and nine men) who underwent GDC coiling of aneurysms. Every aneurysm had either a wide neck or a sac diameter/neck size ratio (SNR) of 1.5 or less.

Results: In four (8%) of the procedures, balloon placement failed, leaving a total of 45 aneurysms treated with balloon-assisted coiling. Final results consisted of total occlusion in 30 cases (67%), subtotal occlusion in 11 cases (24%), and incomplete occlusion in four cases (9%). We found a correlation between the diameter of the sac and the occlusion rate, but not between the size of the neck or the SNR and the occlusion rate. Two thromboembolic complications occurred, but neither had clinical consequences. No aneurysmal rupture was observed during treatment. Final angiographic follow-up time ranged from 3 months to 5 years (mean, 16 months).

Conclusion: Balloon-assisted coiling is an important adjunct in the treatment of aneurysms with a wide neck or low SNR. In our experience, this technique allowed safe and efficient treatment of aneurysms when conventional GDC treatment had failed.

fig 1.

75-year-old-woman with SAH. A, Anteroposterior right carotid angiogram shows a broad-based aneurysm at the termination of the internal carotid artery. B, Digital radiograph shows failed attempt to treat the aneurysm with conventional coiling owing to bulging of the coil into the parent artery. C, Digital radiograph shows that latex balloon glued onto a Magic microcatheter is temporarily inflated in the parent artery at the level of the aneurysmal neck. Several coils have been positioned through the microcatheter placed in the aneurysm. Additional coils have been delivered to achieve occlusion. D, Final angiogram at the end of the procedure shows occlusion of the aneurysm.

fig 2.

60-year-old woman. A, Cerebral angiogram (lateral projection) 1 month after partial occlusion of a ruptured wide-necked carotid-ophthalmic aneurysm performed emergently with a conventional GDC procedure. Remaining pouch has a triangular shape with a broad neck. B, The first coils have been inserted into the aneurysm with the balloon inflated and bridging the aneurysmal neck. C and D, Cerebral angiograms, lateral (C) and anteroposterior (D) projections, show complete occlusion of the aneurysm.

fig 3.

37-year-old-woman with SAH. A, Cerebral angiogram (anteroposterior projection) reveals a large, wide-necked basilar artery tip aneurysm. Patient was not a candidate for surgery, and treatment with GDCs was impossible without using a protection balloon placed in front of the aneurysmal neck during coil deployment. B, Digital radiograph shows the Solstice catheter has been advanced through the left vertebral artery, with the microwire anchored in the left P1 segment. After deployment of the coil into the inferior part of the aneurysm, and before its detachment, the balloon bridging the aneurysmal neck was slowly deflated. C, Cerebral angiogram at the end of the procedure shows subtotal occlusion of the aneurysm. The right P1 segment is occluded, but the posterior cerebral artery is fed by the right posterior communicating artery. No neurologic deficit is observed. D, Cerebral angiogram 15 months after treatment shows stability of the occlusion.