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Waffle-cone technique with Solitaire™ AB Remodeling Device: endovascular treatment of highly selected complex cerebral aneurysms

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

To evaluate patients with complex aneurysms who underwent waffle-cone stent-assisted coil embolization.

Methods

From February 2008 to February 2010, consecutive data were collected from 80 patients with aneurysms treated with the Solitaire™ AB Remodeling Device followed by a standard coiling procedure using bare or/and bioactive coils. Six of these patients were treated using the “waffle-cone-technique” placing the distal end of a stent directly into the base of a bifurcation aneurysm and coiling through the expanded and cone-shaped distal end of the stent allowing for preservation of parent artery patency. The aneurysms were located at the P3 segment of the posterior cerebral artery (n = 1), the middle cerebral artery bifurcation (n = 1), the basilar tip (n = 2), and the AComAnt (n = 2). Four patients underwent follow-up (2–7 months, mean 4.5 months).

Results

Waffle-cone positioning of the Solitaire™ AB Remodeling Device was obtained in all cases without technical problems. No permanent procedural morbidity was observed. In all patients, a Raymond class 2 occlusion was obtained and five patients left the hospital with a good clinical status (mRS0 n = 3, mRS1 n = 1) or no new neurologic deficits (mRS4 n = 1). One patient with SAH III died due to severe vasospasms. Due to major recanalization during follow-up, retreatment was necessary or is planned in four cases; one asymptomatic intimal hyperplasia was observed 8 weeks after initial treatment.

Conclusion

The waffle-cone technique may enhance the possibilities of the endovascular treatment of these complex aneurysms. Due to the high rate of recanalization requiring endovascular retreatment, stringent angiographic and clinical follow-up is warranted.

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Conflict of interest statement

J. Klisch and M. Holtmannspötter consult to ev3.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology & Neuroradiology, HELIOS General Hospital Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany

    Vojtech Sychra, Joachim Klisch, Maren Werner & Christoph Strasilla

  2. Department of Radiology, General Hospital Brandenburg, Brandenburg, Germany

    Christian Dettenborn

  3. Department of Interventional Radiology and Neuroradiology, Zentralklinik Bad Berka, Bad Berka, Germany

    Alexander Petrovitch

  4. Department of Neurosurgery, HELIOS General Hospital Erfurt, Erfurt, Germany

    Rüdiger Gerlach & Steffen Rosahl

  5. Department of Neuroradiology, University of Munich, Munich, Germany

    Markus Holtmannspötter

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  1. Vojtech Sychra
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  2. Joachim Klisch
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  7. Rüdiger Gerlach
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  9. Markus Holtmannspötter
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Correspondence to Joachim Klisch.

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Sychra, V., Klisch, J., Werner, M. et al. Waffle-cone technique with Solitaire™ AB Remodeling Device: endovascular treatment of highly selected complex cerebral aneurysms. Neuroradiology 53, 961–972 (2011). https://doi.org/10.1007/s00234-010-0766-6

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  • DOI: https://doi.org/10.1007/s00234-010-0766-6

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