Preservation of Branching Vessel Using Super Compliant Double-Lumen Balloon Microcatheter: Bulging Neck Plasty Technique and Other Options

Abstract

Objective: There are several methods to treat wide-neck aneurysms. We survey the cases that were treated using a super-compliant double-lumen balloon microcatheter (Super-Masamune) for preservation of the branching vessel originating proximal to the aneurysm, especially in the bulging neck plasty (BNP) technique.

Methods: We assessed 10 cases in which branching vessel preservation was performed using Super-Masamune. The cases were categorized into three groups: (1) ordinary neck plasty (ONP): balloon microcatheter was navigated to the branch that should be preserved; (2) BNP: another branch was preserved by inflating balloon bulging without cannulation; (3) protection during parent artery occlusion (PPO): the balloon microcatheter was navigated to the vessel to be occluded. The balloon preserves a branch originating near the aneurysm without cannulating to the branch.

Results: The aneurysm locations were as follows: internal carotid artery (ICA), three cases; anterior communicating artery (AcomA), one case; basilar artery (BA), three cases; and vertebral artery (VA), three cases. Four cases were ruptured aneurysms, while six cases were unruptured or ruptured in chronic stage. The ONP, BNP, and PPO groups contained two, five, and three cases, respectively. Embolization resulted in complete obliteration in six cases, neck remnant in two cases and body filling in two cases. No rupture/rerupture was noted in this series. One case showed an intraoperative rupture.

Conclusion: Super-Masamune is useful for neck plasty, especially BNP, in wide-neck aneurysms. Super-Masamune is also useful for parent artery occlusion when an important branch originates proximal to the aneurysm.

Keywords: balloon assist; embolization; neck plasty; parent artery occlusion.

Fig. 1. VA angiograms, obtained in the antero-posterior view, of Case 4. (A) A 3D DSA image obtained just prior to the first embolization showing the BA—left SCA aneurysm. Note that the left SCA is originating from the aneurysm dome. (B) Angiogram obtained just prior to the second embolization, 9 months after the first embolization, showing recanalization of the aneurysm. (C and D) Skull X-p during coil insertion. White dots indicate shape of inflated Super-Masamune (D). Note that balloon bulges the left SCA (white arrow) and right PCA (white arrowhead). (E) An angiogram obtained just after embolization showing the neck remnant. Note that the left SCA is completely preserved. PCA: posterior cerebral artery; SCA: superior cerebellar artery; VA: vertebral artery

Fig. 2. Left internal carotid angiograms, obtained in the lateral oblique view, in Case 6. (A) A 3D DSA image just prior to embolization. The left PcomA is originating from the aneurysm dome. (B) Skull X-p during coil insertion. Note that the balloon is bulging in the aneurysm. (C) An angiogram obtained just after embolization showing body filling. Left PcomA is completely preserved. PcomA: posterior communicating artery

Fig. 3. VA angiograms, obtained in the antero-posterior caudal view, in Case 8. (A) An angiogram showing right VA dissection. Note that the right PICA is originating from the distal end of dissection. (B) Skull X-p during coil insertion. The white arrow indicates the inflated Super-Masamune. (C) Left VA angiogram just after coiling. The right PICA is filled via the left VA. PICA: posterior inferior cerebellar artery; VA: vertebral artery