Balloon-assisted Coiling Research Articles

Comaneci-Assisted Coiling of Wide-Necked Intracranial Aneurysm: A Single-Center Preliminary Experience.

Wide-necked aneurysms remain challenging for both coiling and microsurgical clipping. They often require additional techniques to prevent coil prolapse into the parent artery, such as balloon- and stent-assisted coiling. Comaneci is an expandable and removable stent that acts as a bridging device and does not interfere with the blood flow of the parent artery. We retrospectively reviewed our institutional radiological and clinical chart of patients treated for saccular intracranial aneurysm via endovascular Comaneci-assisted coiling. The aim of the study was to report our preliminary experience in Comaneci-assisted coiling of wide-necked intracranial aneurysms. We included 14 patients in the study. Of these, 11 had a ruptured intracranial aneurysm and were treated with Comaneci-assisted coiling. We registered five minor intraprocedural complications and two intraprocedural failures of the device. At one-year follow-up, a satisfying aneurysm occlusion was observed in 85% of the cases. Though long-term follow-up data and larger case series are needed, this preliminary study showed the feasibility of the Comaneci-assisted coiling method for both ruptured and unruptured wide-neck intracranial aneurysms, with similar occlusion rates as balloon-assisted coiling. However, we registered high incidence of thromboembolic complications; these were probably related to the lack of heparin administration. The main advantageous application of this technique is likely in cases of ruptured intracranial aneurysms, as there is no need for post-procedural antiplatelet therapy.

Anterior superior pancreaticoduodenal artery pseudoaneurysm after distal pancreatectomy with en bloc celiac axis resection successfully treated with balloon-assisted coil embolization

Bleeding is a fatal complication after pancreatectomy. Although coil embolization is a widely accepted treatment option, ischemia of the remaining organs should be prevented. This study reports the successful treatment of intra-abdominal hemorrhage following distal pancreatectomy with en bloc celiac axis resection (DP-CAR) using balloon-assisted coil embolization (BACE). A 59-year-old man was diagnosed with locally advanced pancreatic cancer. The tumor involves the common hepatic artery, splenic artery, and celiac artery. After four cycles of treatment with gemcitabine/nab-paclitaxel, the soft-density masses, surrounding the artery, shrunk. DP-CAR and R0 resections were performed. A minor postoperative pancreatic fistula occurred. Six months postoperatively, the computed tomography showed delayed asymptomatic bleeding from an anterior superior pancreaticoduodenal artery (ASPDA) pseudoaneurysm located near the gastroduodenal artery confluence. BACE was performed by placing a microballoon catheter in the region of confluence of the ASPDA and posterior superior pancreaticoduodenal artery (PSPDA) to prevent coil migration. After inserting the microballoon catheter, coil embolization was performed in the ASPDA. Hepatic blood flow was maintained from the PSPDA. BACE is a useful technique to preserve blood flow to the remnant organs when performing coil embolization for bleeding following a distal pancreatectomy, especially following a DP-CAR.

Combined endovascular and microsurgical treatment of multiple cerebral aneurysms

Recent advances in interventional neuroradiology brought all multiple cerebral aneurysms (MCA) could be occluded using endovascular techniques. A multimodal approach (combined microsurgical and endovascular) should be considered as a possible treatment option for MCA to improve treatment outcomes by simplifying the technical complexity of endovascular occlusion and providing sustained long-term occlusion.Objective ‒ to analyze the results of combined microsurgical and endovascular treatment of MCA.Materials and methods. A retrospective analysis of the results of evaluation and surgical treatment of 172 patients with MCA in Scientific-practical Center of Endovascular Neuroradiology NAMS of Ukraine from April 2016 to February 2022. In 7 (4.1 %) patients, combined endovascular and microsurgical treatment of MCA was done.Results. In 7 patients (4 women and 3 men, mean age ‒ 39.3 years), 19 aneurysms (size from 3 to 15 mm) were detected, of which 15 (78.9 %) were located in the anterior semicircle, 4 (21.1 % ) ‒ in the posterior. All aneurysms of the basilar circulation were excluded using endovascular approach. In 4 (57.1 %) patients, the aneurysms were ruptured. Ten (52.6 %) aneurysms were occluded endovascularly (6 with coil s only, 2 with balloon-assisted coiling, 1 with stent-assisted coiling, and 1 with flow-deverter stent), 9 (47.4 %) aneurysms were clipped. One (5.3 %) periprocedural complication after endovascular treatment was noted ‒ prolapse of the coil into the vessel. In 2 (22.2 %) cases, residual aneurysm was detected after clipping, which was occluded with coils. The rate of total aneurysm occlusion at discharge was 94.7 %. All patients were discharged from the hospital with favorable results (score ≤2 points on the modified Rankine scale). Stable effective occlusion after 3 months was noted in 17 (89.5 %) aneurysms, 2 (10.5 %) aneurysms were filled at the level of the neck.Conclusions. Combined endovascular and microsurgical treatment is a technically feasible treatment option for MCA and is considered in patients where the conventional approach with either method has failed or is associated with a high risk of complications. Our series has demonstrated the safety and efficacy of combined MCA treatment.

WEB embolization of very broad-based intracranial aneurysms with a dome-to-neck ratio ≤ 1.1.

The Woven EndoBridge (WEB) is a well-studied intrasaccular device for endovascular treatment of wide-necked bifurcation aneurysms. We evaluated the feasibility, safety and efficacy of the WEB for the treatment of very broad-based aneurysms with a dome-to-neck ratio ≤ 1.1. Thirty-four aneurysms treated at three neurovascular centers were retrospectively identified. The mean aneurysm size was 5.5 ± 1.6 mm with a mean neck width of 4.7 ± 1.5 and a mean dome-to-neck ratio of 1.0 ± 0.1. The primary outcome measures were immediate technical treatment success by WEB only, complete or near-complete occlusion at 6-month follow-up and ischemic stroke. Aneurysm embolization by WEB only was technically feasible in 79.4%. Additional stenting was required in 14.7%. In two aneurysms (5.9%), WEB implantation failed, and the aneurysm was treated by stent- and balloon-assisted coiling, respectively. Thromboembolic events occurred during 5 interventions (14.7%), all of these performed in ruptured aneurysms. One patient (2.9%) remained asymptomatic (follow-up modified Rankin scale [mRS] score: 0), 2 patients (5.9%) had a transient deficit (mRS 0 and 1, respectively), and 2 (5.9%) had a disabling ischemic stroke (mRS 3, respectively). Mid-term angiographic follow-up of 29 patients (4.0 ± 2.6 months, range: 2-9 months) showed complete occlusion (WEB occlusion scale [WOS] A) in 41.4%, near-complete occlusion (WOS B) in 34.5%, a neck remnant (WOS C) in 10.3%, and aneurysm remnants (WOS D) in 13.8%. WEB embolization of very broad-necked aneurysms was technically feasible and could be achieved by WEB only in the majority of cases. Considering the challenging anatomy of very broad-based aneurysms, the WEB procedure was reasonably safe and efficient.

Intracranial wide neck aneurysms: clinical and angiographic outcomes of endovascular management

BackgroundThe treatment of intracranial wide neck aneurysms (WNAs) is usually difficult, hence several endovascular techniques were developed. This study aims to assess the clinical and angiographic imaging outcome of endovascular management of intracranial wide neck aneurysm. Forty patients were referred to the neuro-endovascular unit, at our hospital, each with a wide neck aneurysm. They were assessed regarding clinical presentation, aneurysm size, the character of the aneurysm, and the age and sex of the patient. Post-procedural, clinical, and angiographic outcomes of the patients who underwent endovascular intervention were reviewed.ResultsIn this study, the mean aneurysmal neck was 5.4 ± 1.6 mm (mm). Endovascular intervention was carried out in all 40 patients in the form of simple coiling in 3 patients, double-catheter technique in 5 patients, balloon-assisted coiling (BAC) in 16 patients, stent-assisted coiling (SAC) in 13 patients, and flow diverter (FD) in 3 patients. Regarding clinical outcome, 4 patients had unfavorable outcome (the modified Rankin Scale, mRS > 2) at presentation and 3 patients at discharge. There was no unfavorable clinical outcome at 6- and 12-month follow-ups. Overall angiographic outcome at 1-year follow-up, 37/40 aneurysms (92.5%) had complete occlusion while two aneurysms had neck recurrence and one aneurysm had neck recanalization.ConclusionThe current endovascular techniques in the treatment of WNAs are considered effective, feasible, and safe.

Endovascular therapy versus microsurgical clipping of unruptured wide-neck aneurysms: a prospective multicenter study with propensity score analysis.

Numerous techniques have been developed to treat wide-neck aneurysms (WNAs), each with different safety and efficacy profiles. Few studies have compared endovascular therapy (EVT) with microsurgery (MS). The authors' objective was to perform a prospective multicenter study of a WNA registry using rigorous outcome assessments and to compare EVT and MS using propensity score analysis (PSA). Unruptured, saccular, not previously treated WNAs were included. WNA was defined as an aneurysm with a neck width ≥ 4 mm or a dome-to-neck ratio (DTNR) < 2. The primary outcome was modified Rankin Scale (mRS) score at 1 year after treatment (good outcome was defined as mRS score 0-2), as assessed by blinded research nurses and compared with PSA. Angiographic outcome was assessed using the Raymond scale with core laboratory review (adequate occlusion was defined as Raymond scale score 1-2). The analysis included 224 unruptured aneurysms in the EVT cohort (n = 140) and MS cohort (n = 84). There were no differences in baseline demographic characteristics, such as proportion of patients with good baseline mRS score (94.3% of the EVT cohort vs 94.0% of the MS cohort, p = 0.941). WNA inclusion criteria were similar between cohorts, with the most common being both neck width ≥ 4 mm and DTNR < 2 (50.7% of the EVT cohort vs 50.0% of the MS cohort, p = 0.228). More paraclinoid (32.1% vs 9.5%) and basilar tip (7.1% vs 3.6%) aneurysms were treated with EVT, whereas more middle cerebral artery (13.6% vs 42.9%) and pericallosal (1.4% vs 4.8%) aneurysms were treated with MS (p < 0.001). EVT aneurysms were slightly larger (p = 0.040), and MS aneurysms had a slightly lower mean DTNR (1.4 for the EVT cohort vs 1.3 for the MS cohort, p = 0.010). Within the EVT cohort, 9.3% of patients underwent stand-alone coiling, 17.1% balloon-assisted coiling, 34.3% stent-assisted coiling, 37.1% flow diversion, and 2.1% PulseRider-assisted coiling. Neurological morbidity secondary to a procedural complication was more common in the MS cohort (10.3% vs 1.4%, p = 0.003). One-year mRS scores were assessed for 218 patients (97.3%), and no significantly increased risk of poor clinical outcome was found for the MS cohort (OR 2.17, 95% CI 0.84-5.60, p = 0.110). In an unadjusted direct comparison, more patients in the EVT cohort achieved a good clinical outcome at 1 year (93.4% vs 84.1%, p = 0.048). Final adequate angiographic outcome was superior in the MS cohort (97.6% of the MS cohort vs 86.5% of the EVT cohort, p = 0.007). Although the treatments for unruptured WNA had similar clinical outcomes according to PSA, there were fewer complications and superior clinical outcome in the EVT cohort and superior angiographic outcomes in the MS cohort according to the unadjusted analysis. These results may be considered when selecting treatment modalities for patients with unruptured WNAs.

Endovascular Therapy Versus Microsurgical Clipping of Ruptured Wide Neck Aneurysms (EVERRUN Registry): a multicenter, prospective propensity score analysis.

Randomized controlled trials have demonstrated the superiority of endovascular therapy (EVT) compared to microsurgery (MS) for ruptured aneurysms suitable for treatment or when therapy is broadly offered to all presenting aneurysms; however, wide neck aneurysms (WNAs) are a challenging subset that require more advanced techniques and warrant further investigation. Herein, the authors sought to investigate a prospective, multicenter WNA registry using rigorous outcome assessments and compare EVT and MS using propensity score analysis (PSA). Untreated, ruptured, saccular WNAs were included in the analysis. A WNA was defined as having a neck ≥ 4 mm or a dome/neck ratio (DNR) < 2. The primary outcome was the modified Rankin Scale (mRS) score at 1 year posttreatment, as assessed by blinded research nurses (good outcome: mRS scores 0-2) and compared using PSA. The analysis included 87 ruptured aneurysms: 55 in the EVT cohort and 32 in the MS cohort. Demographics were similar in the two cohorts, including Hunt and Hess grade (p = 0.144) and modified Fisher grade (p = 0.475). WNA type inclusion criteria were similar in the two cohorts, with the most common type having a DNR < 2 (EVT 60.0% vs MS 62.5%). More anterior communicating artery aneurysms (27.3% vs 18.8%) and posterior circulation aneurysms (18.2% vs 0.0%) were treated with EVT, whereas more middle cerebral artery aneurysms were treated with MS (34.4% vs 18.2%, p = 0.025). Within the EVT cohort, 43.6% underwent stand-alone coiling, 50.9% balloon-assisted coiling, 3.6% stent-assisted coiling, and 1.8% flow diversion. The 1-year mRS score was assessed in 81 patients (93.1%), and the primary outcome demonstrated no increased risk for a poor outcome with MS compared to EVT (OR 0.43, 95% CI 0.13-1.45, p = 0.177). The durability of MS was higher, as evidenced by retreatment rates of 12.7% and 0% for EVT and MS, respectively (p = 0.04). EVT and MS had similar clinical outcomes at 1 year following ruptured WNA treatment. Because of their challenging anatomy, WNAs may represent a population in which EVT's previously demonstrated superiority for ruptured aneurysm treatment is less relevant. Further investigation into the treatment of ruptured WNAs is warranted.

Balloon-Assisted Coil Embolization and Balloon Angioplasty for Post Subarachnoid Hemorrhage Vasospasm: Initial Experience with Scepter Mini Balloon.

The scope of this technical note is to report our experience with balloon remodeling for wideneck aneurysms and balloon angioplasty of post-subarachnoid hemorrhage vasospasm using the novel Scepter Mini balloon (SMB). Five cases were treated with balloon remodeling for aneurysmal subarachnoid hemorrhage, 2 of which were additionally treated with angioplasty due to post-bleeding vasospasm. All patients had their aneurysm located on parent vessels with a diameter smaller than 2 mm. Complete occlusion was noted in all aneurysms, and the patients had no short-term complications attributed to the catheterization. Additionally, we confirm the previously reported smooth navigation of the balloon through vessels with tortuous anatomy without catheter-induced vasospasm. Based on our experience, the SMB can be a safe and efficient device for applying the balloon remodeling technique for distally located wide-neck aneurysms and distal balloon angioplasty.

The Woven EndoBridge (WEB) device: feasibility, techniques, and outcomes after FDA approval.

Wide-neck bifurcation cerebral aneurysms have historically required either clip ligation or stent- or balloon-assisted coil embolization. This predicament led to the development of the Woven EndoBridge (WEB) aneurysm embolization system, a self-expanding mesh device that achieves intrasaccular flow disruption and does not require antithrombotic medications. The authors report their operative experience and 6-month follow-up occlusion outcomes with the first 115 aneurysms they treated via WEB embolization. The authors reviewed the first 115 cerebral aneurysms they treated by WEB embolization after FDA approval of the WEB embolization device (from February 2019 to January 2021). Data were collected on patient demographics and clinical presentation, aneurysm characteristics, procedural details, postembolization angiographic contrast stasis, and functional outcomes. A total of 110 patients and 115 aneurysms were included in our study (34 ruptured and 81 unruptured aneurysms). WEB embolization was successful in 106 (92.2%) aneurysms, with a complication occurring in 6 (5.5%) patients. Contrast clearance was seen in the arterial phase in 14 (12.2%) aneurysms, in the capillary phase in 16 (13.9%), in the venous phase in 63 (54.8%), and no contrast was seen in 13 (11.3%) of the aneurysms studied. Follow-up angiography was performed on 60 (52.6%) of the aneurysms, with complete occlusion in 38 (63.3%), neck remnant in 14 (23.3%), and aneurysmal remnant in 8 (13.3%). Six (5.5%) patients required re-treatment for persistent aneurysmal residual on follow-up angiography. The WEB device has been successfully used for the treatment of both unruptured and ruptured wide-neck bifurcation aneurysms by achieving intrasaccular flow diversion. Here, the authors have shared their experience with its unique technical considerations and device size selection, as well as critically reviewed complications and aneurysm occlusion rates.

Rabbit Elastase Aneurysm Model Mimics the Recurrence Rate of Human Intracranial Aneurysms following Platinum Coil Embolization.

Intracranial aneurysms treated with coils have been associated with incomplete occlusion, particularly in large or wide-neck aneurysms. This study aimed to validate the accuracy of the rabbit elastase model in predicting aneurysm recurrence in humans treated with platinum coils. Elastase-induced saccular aneurysms were induced in rabbits and embolized with conventional platinum coils. The recurrence rates of aneurysms were retrospectively analyzed. Morphologic characteristics of aneurysms, angiographic outcomes, and histologic healing were evaluated. A total of 28 (15.3%) of 183 aneurysms recurred. The aneurysm recurrence rate observed in this study (15.3%) is similar to those reported in multiple analyses of aneurysm recurrence rates in humans (7%-27%). The rate of recurrence was higher in aneurysms treated without balloon assistance (19/66, 28.8%) compared with those treated with balloon assistance (9/117, 7.7%). Aneurysms treated with balloon-assisted coiling had a lower recurrence rate (OR = 0.17; 95% CI, 0.05-0.47; P = .001) and higher occlusion rate (OR = 6.88; 95% CI, 2.58-20.37; P < .001) compared with those treated without balloon-assisted coiling. In this rabbit elastase-induced aneurysm model, packing density and aneurysm volume were weak predictors of aneurysm recurrence; however, the packing density was a good predictor of the occlusion rate (OR = 1.05; 95% CI, 1.02-1.10; P = .008). The rabbit elastase aneurysm model may mimic aneurysm recurrence rates observed in humans after platinum coil embolization. Moreover, balloon assistance and high packing densities were significant predictors of aneurysm recurrence and occlusion.

Fogarty-assisted transcatheter embolization of a large renal high-flow arteriovenous fistula

BackgroundRenal high-flow arteriovenous fistulas and its complications may involve high output heart failure, hematuria, hypertension or lethal hemorrhage.Case presentationThis case report covers the case of a 65-year-old male patient with a large renal high-flow arteriovenous fistula of the right kidney (RAVF), treated with balloon-assisted coil and liquid (n-Butyl Cyanoacrylate) embolization. By use of ballon-occlusion with an over-the-wire Fogarty catheter and advancement of a microcatheter through the lumen distal to the balloon during the transcatheter embolization of a high-flow RAVF, control of arterial blood flow is feasible by temporary occlusion of the afferent artery. This technique of flow modulation facilitates controlled deployment of embolization materials and decreases the risk of inadvertent distal embolization by use of only one 6-French (F) arterial sheath.ConclusionsBalloon-assisted embolization using a Fogarty occlusion catheter represents a feasible, safe and effective treatment option for the treatment of large, high-flow arteriovenous fistulas of the kidney.

Deployment of low-profile flow-diverter through a double lumen balloon catheter (remo-diversion technique) to treat recurrent middle cerebral artery bifurcation aneurysm: A technical note.

Wide neck intracranial aneurysms are often difficult to treat with coiling alone, and sophisticated techniques such as balloon-assisted coiling, stent-assisted coiling, flow-diversion, or intrasaccular flow-disruption are sometimes required.This technical note reports the endovascular treatment of a recurrent middle cerebral bifurcation aneurysm by remodeling technique followed by flow-diverter (Silk Vista Baby) deployment through a remodeling balloon (double lumen balloon Eclipse 2L).

Modified balloon-assisted coiling instead of acute stenting in the treatment of ruptured wide necked intracranial aneurysms.

The aim of this study was to investigate the safety and efficiency of the modified balloon assisted coiling (mBAC) technique in endovascular treatment (EVT) of ruptured wide-necked aneurysms (WNAs) to avoid stent placement in the acute phase of subarachnoid hemorrhage (SAH). The local neurointerventional radiology database was retrospectively reviewed to identify patients who underwent EVT due to ruptured WNAs by the authors. According to the EVT technique performed, the study sample was divided into 3 groups: conventional BAC, stent assisted coiling (SAC), and mBAC. The patient demographics, aneurysm features, technical and clinical complications, aneurysm occlusion grades, morbidity, and mortality rates were comparatively analyzed. This study involved a total of 113 patients who had ruptured WNAs. The mBAC technique was performed on 26 aneurysms (23 saccular and 3 fusiform) in 26 patients to avoid acute phase stenting. The mean continuous balloon inflation time was 7.1 ± 2.12 min. The initial and follow-up angiographic and clinical outcomes were better in the mBAC group than in the SAC group (p < 0.05). The mBAC technique offers a prolonged, continuous balloon inflation time during the whole coiling process in the treatment of ruptured WNAs. The mBAC technique has the potential to obviate the need for SAC in patients who are candidates for stenting during the acute phase of SAH, and it might be considered a safe and effective endovascular approach with low complication rates and good angiographic and clinical outcomes.

Effects of the Cerebral Aneurysm Treatment Method on Coil Packing Density and Its Relationship with the Ostium Area

PurposeTo test the following hypotheses: (a) balloon or stent assistance increases coil packing density (CPD) in the endovascular treatment of intracranial aneurysms, and (b) CPD correlates to ostium area (OA) and aneurysm volume (AV). Materials and MethodsThis retrospective study included 60 aneurysms (54 ruptured and 6 unruptured) treated with simple coiling (SC) (n = 18), balloon-assisted coiling (BAC) (n = 7), or stent-assisted coiling (SAC) (n = 35) at the authors’ institution between August 2017 and December 2019. AV and OA measurements were obtained from 3-dimensional digital subtraction angiography images using commercial software. Coil sizes were retrieved from patient files, and coil volume (CV) measurements were obtained from https://www.angiocalc.com/. Analysis of covariance, multivariate covariance analysis, and Pearson correlation analyses were performed. ResultsThe median value for AV, CV, CPD, and OA was 63.4 mm3 (range, 5.5–1,771.4 mm3), 23.13 mm3 (range, 2.03–296.95 mm3), 33.29% (range, 13.41%–81.02%), and 10.7 mm2 (range, 2.7–49.9 mm2), respectively. Multivariate analysis showed that the CPD values were not significantly different among the treatment groups, although OA significantly differed between the SC and SAC groups (P < .05). Pearson correlations showed that similar to AV, OA was negatively correlated with CPD (r = −0.321, P < .05). ConclusionsThe CPD value in cerebral aneurysms treated with BAC or SAC did not differ from that in aneurysms treated with SC.

Balloon-Assisted Coiling of Intracranial Aneurysms: Technical Details and Evaluation of Local Complications.

Wide-neck intracranial aneurysms need additional devices like balloons or stent for management. Balloon-assisted coiling has evolved both with interventionalist experience and device modifications. We discussed our experience, evolution, and complications with this novel technique. Data of 2014-2019 was retrospectively reviewed for type of balloon used along with complications in intracranial aneurysm coiling. Two hundred five aneurysms were detected in 188 patients, of which balloon-assisted coiling was planned for 198 aneurysms. Both single and double-lumen balloons were used. Aneurysms were divided into bifurcation and sidewall aneurysms. The complications were compared between bifurcation and sidewall aneurysms, and between single and double lumen balloons. Balloon-assisted coiling was planned for 198 aneurysms but successfully done for 195 (98.5%) cases. Single-lumen balloons were used in 56 aneurysms (28.3%), and double-lumen balloons were used in 142 cases (71.7%). Procedural thromboembolism within parent vessel was seen in 28 cases (14.1%); however symptomatic were encountered in 5 cases (2.5%). Intraprocedural rupture of the aneurysmal sac was seen in 9 cases (4.5%). The procedure-related mortality in our series was 1.6% (3/188 patients), and morbidity was 4.3% (8/188 patients). The complications among bifurcation and sidewall aneurysms compared between single- and double-lumen balloons showed a greater number of symptomatic thromboembolic complications in sidewall aneurysms with the use of single lumen balloons. There are significant symptomatic thromboembolic complications in sidewall aneurysms with the use of single-lumen balloons which decreased as interventionalist experience evolved and better hardware developed.

A Comparative Evaluation of Standard and Balloon-Assisted Coiling of Intracranial Aneurysms Based on Neurophysiological Monitoring.

Background and purpose: Intracranial aneurysms are commonly treated with balloon-assisted endovascular coiling because the balloon allows for the control und modulation of wide-necked aneurysms and the coil basket. However, this approach might be associated with a higher complication rate. This retrospective study compared the multimodal results between balloon-assisted coiling of aneurysms (group 1) and coiling without balloon assistance (group 2). Materials and Methods: We included 67 patients with unruptured intracranial aneurysms in this retrospective analysis; acutely ruptured aneurysms were excluded from the analysis. We divided these patients into two groups and evaluated them for symptomatic thromboembolic complications in the course of intracranial aneurysm treatment. All patients had an intrainterventional neurophysiological monitoring (IINM) and a pre- and postinterventional NIH Stoke Scale (NIHSS) survey and MR imaging. Multiple logistic regression was used to assess whether balloon-assisted coiling increased the rate of thromboembolic complications. Periprocedural aneurysm hemorrhage did not occur in any of the cases. Results: We detected no statistically significant difference in rates of neurophysiological disturbances (19.5% (group 1) versus 34.6% (group 2); p = 0.249). There was no association with age, gender, or aneurysm location. The occurrence of new diffusion-weighted defects was not statistically significantly different (19.5% (group 1) versus 35.0% (group 2); p = 0.166). The difference in NIHSS before and after the intervention showed also no statistical significance in both groups (p = 0.426). Conclusion: The use of balloon-assisted coiling did not increase the rate of neurological disturbances during endovascular coiling. MR imaging and NIHSS survey also showed no increased risk of embolization from balloon-assisted aneurysm coiling. IINM is a central aspect of care during endovascular coiling as it can substantially decrease morbidity.

Comaneci plus Balloon-assisted Embolization of Ruptured Wide-necked Cerebral Aneurysms.

Recently, avant-garde combinations of ancillary devices as an adjunct to coil embolization for acutely ruptured and wide-necked cerebral aneurysms have emerged. This study sought to investigate the feasibility, safety and durability of the simultaneous combination of temporary neck-bridging devices plus balloon-assisted coiling(BAC) to treat acutely ruptured and wide-necked cerebral aneurysms. Aretrospective review was performed of patients with ruptured and wide-necked intracranial bifurcation aneurysms treated with temporary stent plus balloon-assisted coiling. Anatomical features, technical details, intraprocedural complications, clinical and angiographic results were reviewed. Preprocedural and follow-up clinical statuses were evaluated using the modified Rankin scale(mRS). A total of 21 patients (mean age 54.5 years, range 37-72 years) were identified. The immediate postprocedural angiography revealed complete aneurysm occlusion in 85.7% (18/21) of the cases. Aperiprocedural complication developed in 9.5% of the cases. There was no mortality in this study. The permanent morbidity rate was 4.7%. Long-term follow-up angiography was performed in 18of 21patients (85.7%) (the mean follow-up period was 21months). The rate of complete aneurysm occlusion at final follow-up was 89.4%. The results of this study confirmed that temporary stent plus balloon-assisted coiling is adurable and relatively safe endovascular technique for the treatment of ruptured wide-necked bifurcation aneurysms located in both the posterior and anterior cerebral circulation.

Simple endovascular coiling: An effective long-term solution for wide-necked ruptured middle cerebral artery aneurysms? A 10-years retrospective study.

Endovascular coiling is usually the first line treatment modality for most ruptured intracranial aneurysms. However, there is still some debate as to whether microsurgical clipping or coiling is the treatment of choice for complex wide-necked ruptured middle cerebral artery (MCA) aneurysms. Our aim was to assess the efficacy, safety and longevity of simple endovascular coiling for ruptured MCA aneurysms. This was a single-centre 10years retrospective study (2008-2019) of all endovascularly treated patients with ruptured MCA aneurysms (n = 148). Patients were treated with simple coiling (n = 111), balloon-assisted coiling (n = 13), dual micro-catheter coiling (n = 19), balloon-assisted and dual micro-catheter coiling (n = 4) and woven endobridge (WEB) device (n = 1). The standard follow-up protocol consisted of Magnetic Resonance angiography at 6, 12 and 24months. Our primary endpoints were mortality at 2, 12 and 24months and dependency at discharge. Secondary endpoints included aneurysm occlusion, complications, re-canalisation, rebleeding and retreatment rates. All-cause mortality at 2, 12 and 24months was 4.7% (n = 7), 8.1% (n = 12) and 10.8% (n = 16), respectively. 81.3% of patients remained independent in activities of daily livings (ADLs) at the point of discharge. Over a mean follow-up period of 19.7 months, we demonstrated re-bleeding and re-treatment rates of 2.7% (n = 4) and 4.1% (n = 6) respectively. Complete occlusion was achieved in 54% (n = 79) of aneurysms, with recanalisation observed in 18.2% (n = 27) of the patients. Our results demonstrate that simple endovascular coiling techniques offer a safe and effective solution in the management of ruptured MCA aneurysms without the requirement for re-treatment either surgically or endovascularly using endoluminal stents or other devices.

Short – term outcomes of flow diverter stent (Pipeline) for treatment intracranial aneurysms

Background: With the approval of detachable coils in 1995, endovascular treatment of intracranial aneurysms has become an alternative to surgical clip ligation. Despite the introduction of “modified” coils and advanced techniques such as stent-assisted and balloon-assisted coiling, coil embolization has major limitations because of inability to completely and permanently occlude all aneurysms. As stents were being developed for intracranial use, it was hypothesized that stents could be utilized to divert flow “away” from the aneurysm “back” into the parent vessel, and the concept of “endovascular flow diversion” was proposed. This study aims to report our experience with cerebral aneurysms, which may improve in the treatment with the flow-diverter stent and follow up (1).&#x0D; Methods: This study was conducted in consecutive series of 23 patients. 23 procedures were performed for treating these patients in Ha Noi heart hospital from January 2019 to January 2020. 23 flow diverter stents (Pipeline) were used. Aneurysms morphology, stent patency and cerebral parenchyma before and after intervention were analyzed on images of digital subtraction angiography (DSA), computed tomography (CT) and magnetic resonance (MR). The follow-up data after 3–6 months and 12 months were recorded.&#x0D; Results: In 23 patients (8 men, 15 women), aneurysms of internal carotid artery were mostly common (95.7%), especially in cavernous segments. 13 cases (74%) had saccular aneurysms, and 2 cases (9%) had multiple aneurysms, and only 3 cases (13%) had fusiform aneurysms. Endovascular treatment was successfully performed at rate of 100%.. Mortality and morbidity rates were 0% and 0%, respectively. MRI and MSCT follow-up at 3 months showed complete or incomplete occlusions of aneurysms was 26.1% or 34.8%, respectively. &#x0D; Conclusions: Deployment of flow diverter stent is safe and effective with high rate of successful and low procedural complications

Balloon-Assisted Coil and Liquid Embolizing System Repair of Barrow's Type A Carotico-Cavernous Fistula.

Balloon-Assisted Coil and Liquid Embolizing System Repair of Barrow's Type A Carotico-Cavernous Fistula.