The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago

Aletich, Victor; Debrun, Gérard; Misra, Mukesh; Charbel, Fady T.; Ausman, James I.

doi:10.3171/jns.2000.93.3.0388

Cited by 140 publications

(61 citation statements)

References 14 publications

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“…Therefore, the advisability of treating incidental BA bifurcation aneurysms by endovascular methods, including balloon-assisted techniques, must be considered carefully. 1,9) II. Natural history of cerebral aneurysms treated with GDCs Post-treatment progressive thrombosis, and regrowth and recanalization of neck remnants are strongly dependent on arterial inflow.…”

Section: Relationships Of Aneurysm Size and Location To Outcomementioning

confidence: 99%

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Soeda

Sakai

et al. 2004

Neurol. Med. Chir.(Tokyo)

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The present study assessed the safety and efficacy of embolization using Guglielmi detachable coils (GDCs) in 100 asymptomatic cerebral aneurysms classified as sidewall (70) or terminal (30) aneurysms according to the parent artery (68 small aneurysms with a small neck, 21 small aneurysms with a wide neck, and 11 large aneurysms). A balloon-assisted technique was used in 49 aneurysms. Immediate angiography revealed that 71 aneurysms were completely obliterated. Transient deficits occurred in 19 patients, permanent deficits in four patients, and one patient died. Most complications occurred during or immediately after treatment and resolved within a few minutes to a few weeks. None of the surviving patients manifested significant morbidity at 1-year follow up. Follow-up angiographic study was performed in 79 aneurysms. Rates of recanalization and progressive thrombosis (total occlusion of the residual aneurysm at follow up) were 11% and 38%, respectively, in sidewall aneurysms, and 26% and 0%, respectively, in terminal aneurysms. Treatment with GDCs was effective for patients with small aneurysms with small necks, the morbidity was acceptable, and progressive thrombosis occurred during the follow-up period. GDC treatment achieved unsatisfactory results in patients with small terminal aneurysms with wide necks and in large aneurysms, because the obliteration rate was low, and the recanalization and complication rates were high. Multivariate analysis showed that complete occlusion was associated with small-necked aneurysms, and ischemic events tended to occur in terminal aneurysms and in aneurysms treated by the balloon-assisted technique.

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Section: Relationships Of Aneurysm Size and Location To Outcomementioning

confidence: 99%

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Soeda

Sakai

et al. 2004

Neurol. Med. Chir.(Tokyo)

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“…4,6,15,16,22,23,29,[31][32][33]35,44,45,52,53 Among 879 aneurysms treated with balloon remodeling in the literature, the morbidity ranged from 2.2% to 9% with an average of 3.8%. 1,7,10,27,28,30,34,36,39,42,43,48,50 Multivariate analysis showed that age, ruptured aneurysms, and either aneurysm dome diameter or packing volume are predictive of unfavorable clinical outcomes (p = 0.019 and 0.013, respectively). However, a review of patients' mRS scores from presentation to follow-up clinic appointments demonstrates a general trend toward improved clinical outcomes (Fig.…”

mentioning

confidence: 99%

Single-center experience with a dual microcatheter technique for the endovascular treatment of wide-necked aneurysms

Durst¹,

Starke

Gaughen³

et al. 2014

JNS

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Object. The endovascular treatment of wide-necked aneurysms can be technically challenging due to distal coil migration or impingement of the parent vessel. In this paper, the authors illustrate an alternative method for the treatment of wide-necked intracranial aneurysms using a dual microcatheter technique.Methods. The authors' first 100 consecutive patients who underwent coil embolization of a wide-necked aneurysm using a dual microcatheter technique are reported. With this technique, 2 microcatheters are used to introduce coils into the aneurysm. The coils are deployed either sequentially or concurrently to form a stable construct and prevent coil herniation or migration. Angiographic and clinical outcomes are reported.Results. The technical success rate of the dual microcatheter technique is 91% with a morbidity and mortality of 1% and 2%, respectively. Clinical outcomes are excellent with 93% of patients demonstrating a modified Rankin Scale score of 0-2 at long-term follow-up regardless of their score at presentation. Retreatment rates are 18%.Conclusions. The dual microcatheter technique may be a safe and efficacious first line of treatment for widenecked aneurysms.(http: //thejns.org/doi/abs/10.3171/2014.7.JNS132237) key WorDs • dual • microcatheter • wide-necked • aneurysm • outcomes • vascular disorders • interventional neurosurgeryAbbreviation used in this paper: mRS = modified Rankin Scale. * Drs. Durst and Starke contributed equally to this work. C. R. Durst et al. 1094J Neurosurg / Volume 121 / November 2014 Patient SelectionA wide-necked aneurysm was defined as one having a dome-to-neck ratio of less than 2 or a neck diameter greater than 4 mm. 8,11,14,19 During the evaluated period, true saccular aneurysms were treated using this technique, but dissecting or blister aneurysms were not. Interventional ProcedureAccess to the femoral artery is obtained in a standard fashion. The guiding catheter must be able to simultaneously accommodate 2 microcatheters. The microcatheters can be either preshaped or steam-shaped to improve navigability and stability. The first microcatheter is advanced over a microguidewire into the aneurysm under roadmap guidance. At this point, attempts may be made to coil the aneurysm using a single microcatheter. Once it is determined that the dual microcatheter technique will be needed, a second microcatheter is introduced and advanced into the aneurysm. To prevent inadvertent manipulation, the microcatheter that is not in use is covered with a towel. The second microcatheter is usually steam shaped with a curve different from that of the first catheter so that the 2 microcatheters will occupy different parts of the aneurysm. Care must be taken when positioning the second microcatheter, as it can cause the first microcatheter to migrate forward.Two different general strategies can be described: "interleaving" and "locking."Interleaving Technique. This technique is most often used in particularly wide-necked aneurysms. In such aneurysms it may not be possible to place the ...

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“…For wide-necked aneurysms with an adverse neck-to-dome ratio Moret et al (Moret et al 1997) described a remodeling technique, more results were later reported by Aletich et al (Aletich et al 2000) and Malek et al (Malek et al 2000). It involves placement of a separate balloon microcatheter over the neck of the aneurysm in the parent artery and inflating it during deployment of the coil within the aneurysm.…”

Section: Coil Removalmentioning

confidence: 99%

21 Endovascular Treatment of Posterior Circulation Aneurysms

Nanda¹

2012

Principles of Posterior Fossa Surgery

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The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago

Cited by 140 publications

References 14 publications

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Single-center experience with a dual microcatheter technique for the endovascular treatment of wide-necked aneurysms

21 Endovascular Treatment of Posterior Circulation Aneurysms

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