Waffle-Cone Technique Using Solitaire AB Stent

Abstract

The waffle-cone technique is a modified stent application technique, which involves protrusion of the distal portion of a stent into an aneurysm fundus to provide neck support for subsequent coiling. The authors report two cases of wide necked basilar bifurcation aneurysms, which were not amenable to stent assisted coiling, that were treated using the waffle-cone technique with a Solitaire AB stent. A 58-year-old woman presented with severe headache. Brain CT showed subarachnoid hemorrhage and angiography demonstrated a ruptured giant basilar bifurcation aneurysm with broad neck, which was treated with a Solitaire AB stent and coils using the waffle-cone technique. The second case involved an 81-year-old man, who presented with dizziness caused by brain stem infarction. Angiography also demonstrated a large basilar bifurcation unruptured aneurysm with broad neck. Solitaire AB stent deployment using the waffle-cone technique, followed by coiling resulted in near complete obliteration of aneurysm. The waffle-cone technique with a Solitaire AB stent can be a useful alternative to conventional stent application when it is difficult to catheterize bilateral posterior cerebral arteries in patients with a wide-necked basilar bifurcation aneurysm.

Modified Y-configured stents with the waffle-cone technique by use of Solitaire® stent for patients with wide-necked bifurcation aneurysms

“…The most important advantage of the Solitaire ® stent is the absence on its distal end of a platinum wire that might perforate the aneurysm. Its closed-cell design and multiple retrieval system are the other important advantages over the Neuroform stent [1,2]. Considering all these advantages, we preferred to use the Solitaire ® stent with the waffle cone technique for endovascular treatment of our cases.…”

“…In these cases other endovascular techniques may be unsuccessful in reaching the distal end of the parent artery [1,2,4]. This technique has been used in endovascular treatment of bifurcation aneurysms [2]. The wafflecone technique was first described by Horowitz et al [7] in 2006 for endovascular treatment of wide-necked bifurcation aneurysms with an open-cell Neuroform stent (Boston Scientific).…”

“…The wafflecone technique was first described by Horowitz et al [7] in 2006 for endovascular treatment of wide-necked bifurcation aneurysms with an open-cell Neuroform stent (Boston Scientific). Recently, Guo et al [1], Park et al [2], and Sychra et al [4] performed the waffle-cone technique with a Solitaire ® stent. The most important advantage of the Solitaire ® stent is the absence on its distal end of a platinum wire that might perforate the aneurysm.…”

“…The waffle-cone technique can be useful for wide-necked bifurcation aneurysms with acute angulation between proximal and distal parent arteries. In these cases other endovascular techniques may be unsuccessful in reaching the distal end of the parent artery [1,2,4]. This technique has been used in endovascular treatment of bifurcation aneurysms [2].…”

On Waffle Cones and In Vitro Analysis of Endovascular Aneurysm Treatment

“…When the aneurysm efferent vessel cannot be easily navigated, we have favored deployment of a stent device with the distal stent end deployed within the aneurysm fundus at its neck, with subsequent placement of detachable coils in the aneurysm perched at the distal end of the deployed stent. We have applied this technique with use of both Neuroform and Enterprise stents (Codman, Raynham, Massachusetts, USA) (6,8) and use of the Solitaire stent (Covidien Neurovascular, Irvine, California, USA) for this technique (12) has been described as well. This device configuration has come to be known as a "waffle cone" due to its appearance (8).…”