Neurointervention.  2021 Jul;16(2):132-140. 10.5469/neuroint.2021.00185.

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

• Song Y
• Kwon B
• Al-abdulwahhab AH
• Kurniawan RG
• Suh DC

• KMID: 2517738
• DOI: http://doi.org/10.5469/neuroint.2021.00185

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.

Keyword

Intracranial aneurysm; Embolization, therapeutic; Procedures and techniques utilization

Figure

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  Fig. 1. Concept diagram depicting coiling of the paraclinoid aneurysm using a partially inflated balloon. (A) A loop-shaped microcatheter is introduced into the aneurysm. (B) The coil protrudes out of the aneurysm because of resistance of the coil within the aneurysm and withdrawal of the microcatheter. (C) Coil packing can be accomplished by supporting the microcatheter loop with the partially inflated balloon.

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  Fig. 2. Balloon-assisted coiling for the treatment of a paraclinoid aneurysm. (A) A 4-mm aneurysm with superolateral projection just distal to the anterior genus of the right cavernous internal carotid artery. (B, C) Framing and filling coils are inserted into the aneurysm by supporting the microcatheter with intermittent ballooning (arrows). (D) No contrast filling is seen in the aneurysm on completion angiogram. A tiny opacification within the coil mass was determined as an overlapping ophthalmic artery.

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  Fig. 3. A paraclinoid aneurysm with a relatively well-delineated neck as a pseudo-neck. (A) An internal carotid arteriogram shows an aneurysm at the posterior wall. (B) The aneurysm neck is not resistant to the coils and collapses while introducing the frame coil; thus it is regarded as a pseudo-neck. (C) The coils are contained within the aneurysm via the balloon inflation. (D) Final angiogram shows compact coiling of the aneurysm. (E–H) Concept diagrams of the procedure.

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  Fig. 4. Exchange into stenting after the failure of balloon-assisted coiling. (A) Left internal carotid angiogram shows an aneurysm projecting medially. (B) Despite using a balloon (arrows), the coil protrudes out of the aneurysm. (C) After deploying a stent, the coil is packed in the aneurysm. (D) Complete obliteration of the aneurysm is achieved.

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