Microcatheter Stabilization Technique Using Partially Inflated Balloon for Coil Embolization of Paraclinoid Aneurysms

Abstract

Purpose: Coil embolization of paraclinoid aneurysms should be simple, safe, and effective considering the benign nature of the aneurysm. Here, we present a microcatheter stabilization technique using a partially inflated balloon for the treatment of paraclinoid aneurysms.Materials and Methods: This retrospective study included 58 patients who underwent balloon-assisted coiling (BAC) for unruptured paraclinoid aneurysms at a tertiary neuro-intervention center between January 2019 and March 2020. We applied a technique to stabilize the microcatheter’s position using the modified BAC technique in paraclinoid aneurysms showing various projections around the ophthalmic curve of the internal carotid artery. The basic concept of the technique is to place a partially inflated balloon just distal to the aneurysm neck and support the distal curve of the microcatheter using the proximal bottom of the balloon. Immediate radiological outcomes were analyzed, and clinical outcomes were evaluated with modified Rankin Scale (mRS) scores.Results: The BAC was successfully performed in 51 of 58 patients (88%). We treated the remaining seven patients by switching to stent-assisted coiling. We obtained a 37% mean packing density resulting in favorable occlusion in all 58 aneurysms (complete occlusion in 35 and residual neck in 23). There were no intraprocedural thromboembolic or hemorrhagic events except one that revealed an asymptomatic infarction after the procedure (1.7%). Magnetic resonance angiography follow-up was performed in 37 patients at an average of 11.8 months, in which 11 minor recurrences (29.7%) were found. There was no major recurrence nor retreatment. The mRS score was 0 in all patients during a mean follow-up of 17.7 months (range, 12–25 months).Conclusion: The modified balloon-assisted coiling technique using a partially inflated balloon was safe and effective and could serve as an option for treating paraclinoid aneurysms.

Positional Relationship between Two Microcatheters according to the Navigation Sequence within the Curved Vessel in Neuroendovascular Procedures

“…Balloon-assisted coil embolization has been used for aneurysms in various locations and has also been applied in paraclinoid aneurysms. [3][4][5] Inflation of the balloon for the neckremodeling might have a mechanical conflict with the microcatheter in the aneurysm resulting in its displacement, especially in the tight curve of the paraclinoid ICA. When the balloon is placed between the aneurysmal neck and microcatheter, the balloon inflation may result in unexpected protrusion of the microcatheter and coils, thereby leading to incomplete or impossible coiling of the aneurysm.…”

Positional Relationship between Two Microcatheters according to the Navigation Sequence within the Curved Vessel in Neuroendovascular Procedures

“…Balloon-assisted coil embolization has been used for aneurysms in various locations and has also been applied in paraclinoid aneurysms. [3][4][5] Inflation of the balloon for the neck-remodeling might have a mechanical conflict with the microcatheter in the aneurysm resulting in its displacement, especially in the tight curve of the paraclinoid ICA. When the balloon is placed between the aneurysmal neck and microcatheter, the balloon inflation may result in unexpected protrusion of the microcatheter and coils, thereby leading to incomplete or impossible coiling of the aneurysm.…”

Outpatient Day-Care Management of Unruptured Intracranial Aneurysm: A Retrospective Cohort Study

“…The procedures were performed under general anesthesia for 902 aneurysms (94.4%), and sedative anesthesia for 54 aneurysms (5.6%). The procedural details have been described previously [ 4 5 8 9 10 11 12 13 14 ]. The femoral approach (n = 954 aneurysms) was routinely used, while the radial approach (n = 2 aneurysms) was used in selected patients.…”