Endovascular Treatment of Wide-Necked Intracranial Aneurysms Using Balloon-Assisted Technique with HyperForm Balloon

Abstract

Objective: To assess the feasibility, safety, and effectiveness of the balloon-assisted technique with HyperForm balloon in the endovascular treatment of wide-necked intracranial aneurysms.

Methods: A total of 34 patients with 34 wide-necked intracranial aneurysms were treated with endovascular coil embolization using balloon-assisted technique with Hyperform balloon. Twenty-nine aneurysms (85.3%) were located in the anterior circulation. The group of patients was comprised of 16 men and 18 women, aged 33 to 72 years (mean : 60.6 years). The size of aneurysms was in the range of 2.0 to 22.0 mm (mean 5.5 mm) and one of neck was 2.0 to 11.9 mm (mean 3.8 mm). The dome to neck ratio was ranged from 0.83 to 1.43 (1.15). Sixteen patients were treated for unruptured aneurysms and the remaining 18 presented with a subarachnoid hemorrhage.

Results: In the 34 aneurysms treated by the remodeling technique with HyperForm balloon, immediate angiographic results consisted of total occlusion in 31 cases (91.2%) and partial occlusion in three cases (8.8%). There were five procedure-related complications (14.7%), including two coil protrusions and three thromboembolisms; Except one patient, all were successfully resolved without permanent neurologic deficit. No new bleeding occurred during the follow-up. Twenty patients (59%) underwent angiographic follow-up from 2 to 33 months (mean 9.2 months) after treatment. Focal recanalization with coil compaction of the neck portion was observed in 5 cases (25%). Only one case showed major recanalization and underwent stent-assisted coil embolization.

Conclusion: The balloon-assisted technique with Hyperform balloon is a feasible, safe, and effective endovascular treatment of wide-necked cerebral aneurysms.

Keywords: Balloon-assisted technique; Endovascular treatment; Intracranial aneurysms; Wide-necked aneurysms.

Fig. 1

A 38-year-old man with a ruptured basilar artery top aneurysm. A : Left vertebral artery angiogram shows a basilar artery top aneurysm with unfavorable dome to neck ratio aneurysm. B : HyperForm balloon is positioned across the aneurysm neck and the first coil is inserted into the aneurysm with the balloon inflation and bridging the aneurysmal neck. C : Angiogram after the balloon deflation reveals no coil herniation into parent artery. D : The last coil is inserted into the aneurysm with balloon inflation. E : Immediate post-procedural angiogram demonstrates dense, complete occlusion of the aneurysm without compromising the parent artery. F : Follow up angiogram after 6 months later reveals complete obliteration of the aneurysm.

Fig. 2

Relationship between initial Hunt-Hess grade and mRS at discharge. p = 0.454 by Pearson correlation coefficient. mRS : modified Rankin Scale.

Fig. 3

A 62-year-old man with an unruptured basilar artery top aneurysm. A : Left vertebral artery angiogram reveals a 22.6 mm × 14 mm sized wide-necked basilar artery top aneurysm. B : The last coil is inserted into the aneurysm with balloon inflation. C : Final angiogram demonstrated total occlusion of the aneurysm. D : Follow up angiogram after 12 months later reveals regrowth of the coil-embolized aneurysm. E : Complete occlusion of the regrowth aneurysm with Y-configuration stent-assisted coil embolization. F : Final angiogram shows total occlusion of the aneurysm without parent artery flow compromise.