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DOI: 10.4103/ajns.AJNS_134_17
Double-balloon trapping for coil embolization of ruptured internal carotid artery aneurysm: A novel technique
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Introduction: Endovascular treatment of complex ruptured aneurysms in the internal carotid (IC) artery is extremely challenging. Navigation of double-balloon catheters becomes all the more difficult in tortuous vessels. Patients and Methods: A 57-year-old female with more than three times previously ruptured left IC artery aneurysm with subarachnoid hemorrhage had a left IC small aneurysm with a neck of 3.2 mm. Proximal and distal balloons were inflated in left IC artery in respect to the aneurysm, to prevent further rupture during navigation of the microcatheter and first coil. Discussion: The technique uses two balloons placed proximal and distal to the ruptured aneurysm, to reduce further bleeding, just as the application of temporary clips, followed by inertion of coils rapidly to obliterate the aneurysm. Conclusion: It is a novel technique of double-balloon trapping of proximal and distal segment of IC artery with aneurysm coiling technique as an alternative to balloon-assisted coiling and stent-assisted coiling in patients with ruptured aneurysm.
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Publication History
Article published online:
09 September 2022
© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Guglielmi G, Viñuela F, Duckwiler G, Dion J, Lylyk P, Berenstein A, et al. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 1992;77:515-24.
- 2 Moret J, Cognard C, Weill A, Castaings L, Rey A. The “Remodelling technique” in the treatment of wide neck intracranial aneurysms. Angiographic results and clinical follow-up in 56 cases. Interv Neuroradiol 1997;3:21-35.
- 3 Lefkowitz MA, Gobin YP, Akiba Y, Duckwiler GR, Murayama Y, Guglielmi G, et al. Ballonn-assisted guglielmi detachable coiling of wide-necked aneurysma: Part II – Clinical results. Neurosurgery 1999;45:531-7.
- 4 Aletich VA, Debrun GM, Misra M, Charbel F, Ausman JI. The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: Experience at the university of Illinois at Chicago. J Neurosurg 2000;93:388-96.
- 5 Nelson PK, Levy DI. Balloon-assisted coil embolization of wide-necked aneurysms of the internal carotid artery: Medium-term angiographic and clinical follow-up in 22 patients. AJNR Am J Neuroradiol 2001;22:19-26.
- 6 Cottier JP, Pasco A, Gallas S, Gabrillargues J, Cognard C, Drouineau J, et al. Utility of balloon-assisted Guglielmi detachable coiling in the treatment of 49 cerebral aneurysms: A retrospective, multicenter study. AJNR Am J Neuroradiol 2001;22:345-51.
- 7 Lubicz B, Leclerc X, Gauvrit JY, Lejeune JP, Pruvo JP. HyperForm remodeling-balloon for endovascular treatment of wide-neck intracranial aneurysms. AJNR Am J Neuroradiol 2004;25:1381-3.
- 8 White JB, Layton KF, Kallmes DF, Cloft HJ. Balloon-assisted coiling through a 5-French system. Neuroradiology 2007;49:157-9.
- 9 Ross IB, Dhillon GS. Balloon assistance as a routine adjunct to the endovascular treatment of cerebral aneurysms. Surg Neurol 2006;66:593-601.
- 10 Layton KF, Cloft HJ, Gray LA, Lewis DA, Kallmes DF. Balloon-assisted coiling of intracranial aneurysms: Evaluation of local thrombus formation and symptomatic thromboembolic complications. AJNR Am J Neuroradiol 2007;28:1172-5.
- 11 Arat A, Cil B. Double-balloon remodeling of wide-necked aneurysms distal to the circle of Willis. AJNR Am J Neuroradiol 2005;26:1768-71.
- 12 Kelly ME, Gonugunta V, Woo HH, Turner R 4th, Fiorella D. Double-balloon trapping technique for embolization of a large wide-necked superior cerebellar artery aneurysm: Case report. Neurosurgery 2008;63:291-2.
- 13 Shima H, Nomura M, Muramatsu N, Sugihara T, Fukui I, Kitamura Y, et al. Embolization of a wide-necked basilar bifurcation aneurysm by double-balloon remodeling using HyperForm compliant balloon catheters. J Clin Neurosci 2009;16:560-2.
- 14 Fiorella D, Woo HH. Balloon assisted treatment of intracranial aneurysms: The conglomerate coil mass technique. J Neurointerv Surg 2009;1:121-31.
- 15 Moret J, Pierot L, Boulin A, Castaings L.”Remodelling” of the arterial wall of the parent vessel in the endovascular treatment of intracranial aneurysms. Neuroradiology 1994;36 (Suppl 1):83.
- 16 Takahashi A. Letter to the editor. Neck plastic intra-aneurysmal GDC embolisation with double protective balloons. Method of multiple guiding catheter introduction. Interv Neuroradiol 1998;4:177-9.
- 17 Tumialán LM, Zhang YJ, Cawley CM, Dion JE, Tong FC, Barrow DL, et al. Intracranial hemorrhage associated with stent-assisted coil embolization of cerebral aneurysms: A cautionary report. J Neurosurg 2008;108:1122-9.
- 18 Baxter BW, Rosso D, Lownie SP. Double microcatheter technique for detachable coil treatment of large, wide-necked intracranial aneurysms. AJNR Am J Neuroradiol 1998;19:1176-8.
- 19 Kai Y, Hamada J, Morioka M, Yano S, Mizuno T, Kuratsu J, et al. Double microcatheter technique for endovascular coiling of wide-neck aneurysms using a new guiding device for the transcarotid approach: Technical note. Neuroradiology 2005;47:73-7.
- 20 Albayram S, Selcuk H, Kara B, Bozdag E, Uzma O, Kocer N, et al. Thromboembolic events associated with balloon-assisted coil embolization: Evaluation with diffusion-weighted MR imaging. AJNR Am J Neuroradiol 2004;25:1768-77.