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Abstract
Introduction Coil embolisation of intracranial aneurysms with the help of balloon remodelling of the aneurysm neck is a well-established technique for the treatment of wide necked intra-cranial aneurysms. This requires the use of separate balloon and embolisation microcatheters. Herein, we report the utilisation of a single co-axial dual balloon microcatheter to achieve both coil placement and neck remodelling in a series of intra-cranial and cervical arterial aneurysms.
Materials and Methods A series of 5 patients, (2 with subarachnoid haemorrhage and 3 with unruptured aneurysms) presented to our institution with oblong aneurysms, which measured from 8 mm to 30 mm in their maximum dimensions and 2 mm to 15 mm in their neck width. Of the 2 ruptured aneurysms, one was at the ACOM and the other at the top of the basilar artery. The three unruptured aneurysms consisted of an ACOM aneurysm, a large cervical ICA pseudo-aneurysm and a giant cervical ICA aneurysm with intra-dural extension. Coil embolisation of four of these aneurysms was performed, by advancing the tip of a 4 x 11 mm Scepter XC balloon microcatheter (Microvention, Tustin, USA) into the aneurysm, and placing coils through this microcatheter. The neck of these aneurysms was remodelled by balloon inflation as needed. In the patient with the giant aneurysm at the top of the basilar artery (figure 1a), 2 Scepter XC balloon microcatheters were placed side by side at the neck of the aneurysm, both balloons were inflated (figure 1b) simultaneously and coil embolisation was successfully performed through both Scepter XC microcatheters (figure 1c).
Results Coil embolisation could be successfully performed with this technique in all five aneurysms. There was no instance of aneurysm rupture, thromboembolic complications, occlusion of branch vessels near the aneurysm neck or prolapse of coil loops into the parent vessel.
Conclusion Aneurysmal neck remodelling and coil embolisation can both be safely performed using only a single co-axial dual lumen balloon microcatheter in selected oblong intra-cranial and cervical arterial aneurysms.
Disclosures B. Jagadeesan: 2; C; Microvention, Covidien, Lake Regions, Vital Images. F. Siddiq: None. A. Grande: 2; C; Covidien, Integra, Mueller-Wedel. R. Tummala: 2; C; Lake Regions Medical.