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P-032 “combined remodeling technique” for intracranial aneurysms embolization: low-profile stents delivered through double-lumen balloons: multicenter experience
  1. M MartÍnez-Galdámez1,
  2. G Dabus2,
  3. K Kadziolka3,
  4. M Puthuran4,
  5. V Kalousek5,
  6. A Chandran4,
  7. P Vega6,
  8. B Zheng1,
  9. A Hermosín1,
  10. C Rodríguez1
  1. 1Department of Interventional Neuroradiology/Endovascular Neurosurgery, Fundacion Jimenez Diaz, Madrid, Spain
  2. 2Department of Interventional Neuroradiology/Endovascular Neurosurgery, Miami Cardiac and Vascular Institute, Miami, FL
  3. 3Interventional Neuroradiology. Radiology Department, The Children’s Memorial Health Institute, Western Hospital, Grodzisk Mazowiecki, Poland
  4. 4Interventional Neuroradiology. Radiology Department, The Walton Centre NHS Foundation Trust, Liverpool, UK
  5. 5Interventional Neuroradiology. Radiology Department, Clinical Hospital Center “Sestre Milosrdnice”, Zagreb, Croatia
  6. 6Interventional Neuroradiology. Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain

Abstract

Background and purpose Endovascular treatment of intracranial aneurysms has become a routine first-line option for treatment of an increasing population of intracranial aneurysms at many neurovascular centers. Since appearance of the balloon-remodeling technique and stent-assisted coiling, wide-neck and complex aneurysms have been treated successfully endovascularly worldwide. Although these 2 techniques have been widely proven, the combination of both traditionally required “extra” maneuvers which made the procedures more complicated technically

The aim of our study was to evaluate the technical success, safety and efficacy of the low-profile stents delivered through double lumen balloons.

Material and methods Clinical, procedural, and angiographic data, including aneurysm size and location, device or devices used, angiographic and clinical data were analyzed.

Results Forty nine patients (33 females, 16 males; range 38–79) harboring 49 aneurysms were analyzed. Aneurysms maximal diameter ranged from 2.5 to 26 mm, with 8 mm average. There were 36 unruptured, 8 recanalized (previously ruptured), 1 wrapped (previously ruptured) and 3 ruptured aneurysms. Locations were ACom (17/49 cases), MCA (17/49 cases), M3 (1/49 case), ICA (3/49 cases), Basilar (7/49 cases), PCA-PSA (1/49 case), PICA (1/49 case) and VA (1/49 case).

Scepter (C and XC) and Eclipse 2L double lumen balloons were used. All the low-profile stents available in the market were evaluated, both braided and laser-cut (LVIS junior, LEO Baby, ACCLINO Flex and Neuroform Atlas).

In 32 wide-neck of 49 cases, the operator decided the combined technique as first option; While in 17 of 49 cases, combined techniques were used as a bailout because of branch occlusion, coil protrusion or instability during balloon remodeling.

53 devices were placed properly (23 LVIS jr, 15 LEO Baby, 14 ACCLINO Flex and 1 Neuroform Atlas). Navigation and compatibility were effective in 100% of the cases. All devices were deployed satisfactorily through the double lumen balloons and no device had to be removed.

Initial wall apposition was excellent in 27 devices, 22 devices fully-opened after jailed microcatheter removal and posterior angioplasty was done in 4.

We found 2 minor clinical events (4%) and 1 major event (2%) (Secondary to stents thrombosis in a case where stents were used as bailout because of branches occlusion after intrasaccular device deployment).

We had 3 intraprocedural complications, resolved without clinical consequences (2 in-stent thrombus solved with medication and 1 focal SAH controlled with balloon inflation).

Three months imaging follow-up were obtained in 3 patients, six-month (±1 month) follow-up were obtained in 18 aneurysms, 12–14 months follow-up in 21 aneurysms. Raymond-1 occlusion rate (complete occlusion) was achieved in 66,6%, Raymond-2 obliteration rate (neck remnant) in 31% and Raymond-3 (residual aneurysm) in 2%.

Conclusion The “Combined Remodeling Technique” with low-profile stents delivered through double-lumen balloons is technically easy, feasible, safe and effective for the treatment of intracranial aneurysms. This technique allows the operator to avoid extra maneuvers.

Disclosures M. Martínez-galdámez: None. G. Dabus: None. K. Kadziolka: None. M. Puthuran: None. V. Kalousek: None. A. Chandran: None. P. Vega: None. B. Zheng: None. A. Hermosín: None. C. Rodríguez: None.

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