Intraaneurysmal Embolization for Wide-necked Aneurysms. Remodeling Technique, Combined Neck-Clipping and Coiling Therapy, Scaffolding Technique

Abstract

We reported the results of the endovascular treatment using Guglielmi detachable coil (GDC) for wide-necked aneurysms. Fourteen aneurysms were treated with remodeling technique. One aneurysm was performed endovascular treatment followed by partial neck clipping. The other was treated with scaffolding technique. All aneurysms could not be performed by conventional GDC treatment initially because of coil protrusion into the parent artery due to wide neck of these aneurysms. These aneurysms sited at anterior circulation system in 10 cases, and at posterior circulation system in 6 cases. Immediately after the procedure, the obliteration rate could be obtained complete occlusion in 3 cases, > 95% occlusion in 7 cases, > 90% occlusion in 3 cases and < 90% occlusion in 3 cases. In 14 patients followup angiography or magnetic resonance image (MRI) was carried out. The angiographic follow-up period is range from 2 to 19 months (mean: 10 months). The results of angiographical follow-up indicated increasing obliteration rate with all aneurysms except for 2 cases. In these 2 cases, the reembolization was needed for recanalization of the aneurysm. The clinical follow-up period is range form one to 26 months (mean: 15 months). There is no evidence of aneurysmal rupture and all cases have been survival without any permanent neurological deficits. The GDC treatment with additional technique (remodeling technique, combined neck-clipping and coiling therapy, scaffolding technique) provides safety and effectiveness, even if there are wide-necked aneurysms.

Figure 1

GDC treatment using remodeling technique. A) Left carotid angiogram demonstrated ophthalmic aneurysm with wide neck. B) A microballoon catheter, was introduced into left internal carotid artery, was covered aneurysmal neck. C) On angiogram immediately after procedure, aneurysm was obliterated completely.

Figure 2

Three dimensional CT angiography. Complex aneurysm with wide neck was demonstrated at right middle cerebral artery.

Figure 3

GDC treatment followed neck clipping. A) Large complex aneurysm with wide neck was demonstrated. B) After neck clipping, aneurysm was still visualized. C) On angiogram immediately after embolization, >95% occlusion was achieved. D) Aneurysm was obliterated completely 6 months after embolization.

Figure 4

Contrast enhanced CT scan. Partially thrombosed aneurysm was demonstrated in front of brain stem.

Figure 5

GDC treatment using scaffolding technique. A) On right vertebral angiogram (AP view), irregular shaped aneurysm on right vertebral artery was revealed. B) A gfx stent could cover the aneurysmal neck entirely. C) On angiogram immediately after the procedure, near complete occlusion was achieved. D) AP view on skull XP was seen deposited coils and stent.

Figure 6

GDC treatment using scaffolding technique. A) Two weeks follow-up angiogram demonstrated near complete occlusion. B) On follow-up angiogram 2 months after embolization, recanalization was recognized due to coil compaction and embedding of coils into thrombus. C) The near complete occlusion was obtained by second embolization.