Balloon-Assisted Coiling of Intracranial Aneurysms: Evaluation of Local Thrombus Formation and Symptomatic Thromboembolic Complications

Abstract

BACKGROUND AND PURPOSE:Remodeling balloons are used to assist in endovascular coiling of aneurysms. We evaluated our experience with balloon-assisted coiling (BAC) in an attempt to determine whether this technique increased the rate of thrombus formation or symptomatic thromboembolic complications.

Y-Configuration Stent Placement (Crossing and Kissing) for Endovascular Treatment of Wide-Neck Cerebral Aneurysms Located at 4 Different Bifurcation Sites

“…Moreover, multiple balloon inflations may increase the risk of complications, such as ischemic events, thromboembolism, and even vessel tears secondary to overinflation, 9,10 though the increase of these adverse events remains controversial during single-balloon-assisted coiling. 11 According to some series, in some complex bifurcation aneurysms, especially those in which the base of the aneurysm directly involves both bifurcation branches, a better option may be preserving both branches by using the Y-stent technique. 2,3,12 However, its safety remains yet unknown.…”

Safety and Efficacy of Balloon Remodeling Technique during Endovascular Treatment of Intracranial Aneurysms: Critical Review of the Literature

“…In some series, no comparison was available regarding the rate of complications in both standard coiling and remodeling. 2,4,5 In the Layton et al series, 8 the rate of thrombus formation was not significantly different in patients treated with standard coiling compared with the remodeling technique (9% and 14%, respectively). Symptomatic thromboembolic events were also observed in a similar percentage of cases (5% in standard coiling and 7% in remodeling).…”

“…8 The remodeling technique was more frequently used in unruptured aneurysms (37.3%) than in ruptured aneurysms (20.5%), according to the analyses conducted in the ATENA and CLAR-ITY series. 12,13 According to the ATENA and CLARITY analyses, 12,13 the remodeling technique was used in all aneurysm locations but less frequently in anterior communicating and anterior cerebral aneurysms.…”

“…A few monocentric series were published analyzing clinical and anatomic results of this technique. [3][4][5][6][7][8][9] However, in several of these series, no direct comparison between standard coiling and remodeling was available. Moreover, in most of the literature, ruptured and unruptured aneurysms were mixed, and a separate analysis of the safety and efficacy in both situations was not possible.…”

Is the Risk of Balloon Assistance Underinflated?

“…7 In the mean time, more recent publications have reported complication rates of balloon-assisted coiling to be in the same range as those for conventional coiling. [8][9][10][11] We acknowledge that differences in complication rates with balloon assistance may exist between centers. To some extent, this can be explained by different study time frames, differences in aneurysm selection, anticoagulation regime, and more liberal or restricted use of balloon assistance.…”