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. 2023 May;45(5):465-471.
doi: 10.1080/01616412.2022.2158646. Epub 2022 Dec 19.

Assessment of balloon remodeling techniques in endovascular treatment of wide-neck intracranial aneurysms (WN-IAs)

Nabiel Abd-Elhakeem Metwaly  1 , Khaled Mohammed Sobh  2 , Mahmoud Glal Ahmed  2 , Abd Elaziz Shokry Abd Elaziz  1 , Salah Ibrahim Ahmed  1
Affiliations

Assessment of balloon remodeling techniques in endovascular treatment of wide-neck intracranial aneurysms (WN-IAs)

Nabiel Abd-Elhakeem Metwaly et al. Neurol Res. 2023 May.

Abstract

Objectives: To evaluate the clinical, technical, and angiographic results in endovascular management of wide-neck intracranial aneurysms (WN-IAs) using the balloon-remodeling technique.

Methods: This study was a prospective, single-center study that was carried out over a period of three years from January 2019 to December 2021 at the Neuro-Interventional Unit at our hospital. Patients who presented with WNIAs and were eligible for endovascular treatment using the balloon-remodeling approach were included in the study.

Results: We included 37 patients with a mean age of 49.7 ± 12.3 years. About 91.9% of the participants had SAH, 5.4% had unruptured aneurysms, and 2.7% had intracranial hemorrhage. The mean time to treatment was 6.97 ± 7.35 days, the mean aneurysm diameter was 5.7 ± 1.7 mm, and the mean neck diameter was 3.8 ± 1.0 mm. The majority of the patients had a dom-to-neck ratio of less than 2 (89.2%). We have used hyper form balloons in 48.6%, hyper glide in 43.2%, Copernic balloons in 5.4%, and eclipse in 2.7%. According to the Raymond-Roy occlusion classification, 86.5% of the patients had complete obliteration, 10.8% had residual neck, and 2.7% had a residual aneurysm. Almost 91.9% had no complications, 2.7% had ischemia, and 5.4% had mild rupture by wire, treated by 5 min hyperinflation of the balloon till hemorrhage stopped.

Conclusions: Balloon-assisted detachable coiling is an important option in the treatment of WN-IAs. We found that this technique allowed safe and efficient treatment of aneurysms when conventional treatment had failed due to WN. Endovascular coiling using the balloon remodeling technique of wide neck showed a high technical success rate and good short-term clinical outcomes. A good selection of patients with WN-IAs treated by endovascular coiling using balloon remodeling technique and a good selection of materials used help in decreasing the complications.

Keywords: Angiographic outcomes; Complications; Endovascular treatment; balloon-remodeling; wide-neck intracranial aneurysms.

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