Endovascular Treatment of Wide-Necked Intracranial Aneurysms Using Balloon-Assisted Technique with HyperForm Balloon

Abstract

Objective : To assess the feasibility, safety, and effectiveness of the balloon-assisted technique with HyperForm balloon in the endovascular treatment of wide-necked intracranial aneurysms. Methods : A total of 34 patients with 34 wide-necked intracranial aneurysms were treated with endovascular coil embolization using balloonassisted technique with Hyperform balloon. Twenty-nine aneurysms (85.3%) were located in the anterior circulation. The group of patients was comprised of 16 men and 18 women, aged 33 to 72 years (mean : 60.6 years). The size of aneurysms was in the range of 2.0 to 22.0 mm (mean 5.5 mm) and one of neck was 2.0 to 11.9 mm (mean 3.8 mm). The dome to neck ratio was ranged from 0.83 to 1.43 (1.15). Sixteen patients were treated for unruptured aneurysms and the remaining 18 presented with a subarachnoid hemorrhage. Results : In the 34 aneurysms treated by the remodeling technique with HyperForm balloon, immediate angiographic results consisted of total occlusion in 31 cases (91.2%) and partial occlusion in three cases (8.8%). There were five procedure-related complications (14.7%), including two coil protrusions and three thromboembolisms; Except one patient, all were successfully resolved without permanent neurologic deficit. No new bleeding occurred during the follow-up. Twenty patients (59%) underwent angiographic follow-up from 2 to 33 months (mean 9.2 months) after treatment. Focal recanalization with coil compaction of the neck portion was observed in 5 cases (25%). Only one case showed major recanalization and underwent stent-assisted coil embolization. Conclusion :The balloon-assisted technique with Hyperform balloon is a feasible, safe, and effective endovascular treatment of wide-necked cerebral aneurysms. KEY WORDS :Intracranial aneurysms˙ Wide-necked aneurysms˙ Endovascular treatment˙ Balloon-assisted technique.

Early Experience with the TransForm™ Occlusion Balloon Catheter: A Single-Center Study

“…In the previously reported series with the HyperForm balloon, the authors reported the balloon to be very stable [8,15,16,17]. In our experience, the stability of the TOBC during the first positioning and during inflation and deflation was very steady.…”

“…The safety and efficacy of different balloons (HyperForm; eV3 Inc. and Ascent, Codman Neurovascular) in the treatment of wide-necked cerebral aneurysms has previously been reported in the literature [8,15,16,17,24]. For the very first time in this series, we sought to determine the safety, efficacy and feasibility of the TOBC, which was launched by Stryker Neurovascular in 2013.…”

“…In all cases, the balloon was able to be placed where intended except in 1 case where the tortuosity did not even allow navigation of the wire into the contralateral anterior cerebral artery and hence the balloon was kept in the A1 segment proximal to the neck of the aneurysm for safety only. In the review of their experience with the HyperForm balloon, Lubicz et al [8], Mu et al [15], Youn et al [16] and Cekirge et al [17 ]reported the efficacy of the BACE technique for the treatment of aneurysms located on bifurcations and small arteries. In their experience, the HyperForm balloon was able to change its cylindrical shape easily and to bulge into the origin of arterial bifurcations due to its compliant nature when placed at bifurcations.…”

“…Balloons have also been shown to help in the tamponade of the vessel in case of intraoperative perforation [22,23] and are also used for occlusion testing before sacrifice of the vessel. Previously, Lubicz et al [8], Mu et al [15], Youn et al [16] and Cekirge et al [17 ]reported the use of a super-compliant balloon (HyperForm) in the treatment of wide-necked aneurysms located on arterial bifurcations and/or small arteries. The use of a coaxial dual-lumen balloon catheter (Ascent) for the treatment of wide-necked aneurysms has also been reported by Lazzaro et al [24].…”

“…This has made the use of BACE a more prevalent and preferable approach by clinicians in the last several years to treat wide-necked intracranial aneurysms [3,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21]. Balloons have also been shown to help in the tamponade of the vessel in case of intraoperative perforation [22,23] and are also used for occlusion testing before sacrifice of the vessel.…”