Safety and Efficacy of Adjunctive Balloon Remodeling during Endovascular Treatment of Intracranial Aneurysms: A Literature Review

Flow-Diverter Stents for the Treatment of Saccular Middle Cerebral Artery Bifurcation Aneurysms

“…However, attenuated and complete coil occlusion is not always possible, and recurrence rates are not negligible. 23,24 In these cases, stent-assisted coiling has been increasingly favored, 10,11 but although efficiency rates are good, complication rates appear high for "X" and "Y" configurations, with a 10.0% occurrence of procedure-related permanent neurologic deficits and a 1.0% death rate reported in the study of Bartolini et al 25 The use of FDSs in the treatment of intracranial aneurysms is gradually increasing. The FDS concept is to induce intra-aneurysmal thrombosis by disrupting the flow near the aneurysmal neck while preserving the patency of the parent vessels and the covered branches.…”

Combination of Multicatheter Plus Stent or Balloon for Treatment of Complex Aneurysms

“…[1][2][3][4][5][6][7][8][9][10][11][12] However, if wide-neck aneurysms have an incorporated branch and/or deeply lobulated sac, coiling is more difficult and there is potentially an increased risk of incomplete coiling, a thromboembolic event, or branching occlusion and posttreatment recurrence. The unique configuration of this aneurysm usually demands a more elaborate coiling technique and can be recognized as a complex and difficult aneurysm in view of the coiling procedure.…”

“…The overall incidence of treatment-related complications was reported to be 7.9%-17.1% and 9.4%-12.2% with balloon-and stent-assisted techniques, respectively. 1,[18][19][20][21] The multicatheter technique also ranged from 0% to 13.3%. 5,13,22,23 Notably, in our series, treatment-related morbidity occurred in only 1 patient (1.6%), which is acceptable in comparison with the reported results from the literature focusing only on wide necks and is also remarkable because adding an adjunctive device may lead to an increase in adverse events like thromboembolism and intraprocedural rupture.…”

“…Furthermore, the combination strategy for complex aneurysms had a safety and effectiveness favorably comparable with the single adjunctive endovascular techniques in previous studies. [1][2][3]8,9,[13][14][15][17][18][19][22][23][24][25][26] Our study had several limitations due to its retrospective design and the relatively small number of cases. Therefore, the se- lection bias was inevitable, but it might be somewhat lowered because our data of endovascular treatment were consecutively and prospectively registered.…”

“…Some case series have already reported the feasibility of adjunctive techniques for aneurysms with difficult anatomic characteristics and have presented good procedural outcomes. [1][2][3][4][5][6] However, the coiling procedure of an aneurysm with a wide neck plus an incorporated branch and/or lobulated sac still remains a technical challenge. 6,7 In this regard, those aneurysms should be defined as "complex aneurysms."…”