Neurointervention.  2021 Jul;16(2):165-170. 10.5469/neuroint.2020.00367.

Balloon-Assistance for the Transcirculation Access of a Remodeling Balloon for Coiling of Wide-Necked Aneurysms: Report of Two Cases

• Balaguruswamy MM
• Mohamed E
• Vijayan K
• Juluri CS
• Madeswaran K

• KMID: 2517742
• DOI: http://doi.org/10.5469/neuroint.2020.00367

Abstract

Balloons are valuable tools in the armamentarium of a neurointerventionist. In this report, we describe 2 cases in which a balloon aided in the navigation of a second remodeling balloon through difficult vascular anatomy. The first case was a patient with a ruptured proximal posterior inferior cerebellar artery aneurysm and the second case was a patient with a ruptured anterior communicating artery aneurysm. In both cases, the coiling microcatheter and the remodeling balloon catheters were advanced through different vessels. The remodeling balloon reached the target location using a transcirculation approach, and the navigation of the remodeling balloon was aided by utilizing a second balloon. Challenging vascular anatomy is often encountered when performing neuroendovascular procedures. The strategy of using balloon assistance for the transcirculation access of a remodeling balloon can be used successfully in difficult situations to manage complex aneurysms.

Keyword

Intracranial aneurysm; Endovascular technique; Circle of willis; Therapeutic embolization

Figure

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  Fig. 1. (A) 3D and (B) 2D angiographic images of left VA reveal a wide-necked proximal PICA aneurysm (white arrow). A short fenestration is noted in the VA at the level of PICA origin (circle). (C–F) Four balloon options are shown as 'white line' on 2D image of the PICA aneurysm. (G) The inflated Apollo 4×10 balloon dilatation catheter (black arrow). The Transform 4×10 balloon (double-headed white arrow) in the right vertebral artery with the distal end of the balloon wire in the left PICA. (H) Aneurysm is partially coiled with the inflated Transform balloon (double-headed black arrow). (I) Final angiogram reveals Grade 1 occlusion of the aneurysm. VA, vertebral artery; PICA, posterior inferior cerebellar artery; DSA, digital subtraction angiography.

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  Fig. 2. (A) 3D and (B) 2D angiographic images in working projection reveal a wide-necked ACoA aneurysm (white arrow in A and white double arrows in B). (B) Fenestration noted in right A1-ACA (black asterisk). (C) Right ICA angiogram in frontal projection shows two saccular aneurysms in the right MCA bifurcation (black arrows). (D) First Transform balloon (inflated) in right M1-MCA (white asterisk) and the second Transform balloon (double-headed white arrow) in right A1-ACA with the balloon wire in ACoA and left A2-ACA. (E) Working projection image with coiling microcatheter in the aneurysm and second balloon across aneurysm neck (black double arrowhead). (F) Coil mass in the aneurysm and Transform balloon across aneurysm neck (black double arrows). (G) Final angiogram reveals Grade 0 occlusion of the aneurysm. ACoA, anterior communicating artery; ACA, anterior cerebral artery; ICA, internal carotid artery; MCA, middle cerebral artery.

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