HyperForm balloon-assisted endovascular neck bypass technique to perform balloon or stent-assisted treatment of cerebral aneurysms

Abstract

We describe a technique to bypass aneurysm neck using the HyperForm balloon to perform balloon- or stent-assisted endovascular treatment of complex large or giant aneurysms with very wide neck in which other methods would fail to obtain an access distal to the aneurysm.

Fig 1.

A–D, Roadmap images of the giant ICA aneurysm showing the steps of the balloon-assisted bypass technique. A, The guidewire of the balloon is shown making a loop inside the aneurysm sac. B, Placement of the guidewire distal to the aneurysm in the middle cerebral artery. C, Inflation of the HyperForm balloon placed over the looped wire is demonstrated. D, Image showing the straightening of the looped wire inside the aneurysm sac while the balloon is inflated. E, Nonsubtracted image after the balloon-assisted coil-Onyx combination treatment of the aneurysm. F, Posttreatment image shows the stent placed at the neck of the aneurysm at the end of the balloon-assisted embolization procedure.

Fig 2.

A, Anteroposterior angiographic image showing giant and very wide-necked ICA aneurysm. B, Roadmap image shows the loop inside the aneurysm sac with the balloon placed in the middle cerebral artery. C, Nonsubtracted image shows the straightening of the loop while the balloon is inflated. D, Nonsubtracted image shows the placement of the covered stent bridging the neck of the aneurysm. E, Angiography obtained after the stent graft deployment shows the exclusion of the aneurysm from the circulation.