Balloon Assistance

I n addition to stent-assisted coiling, balloon-assisted coiling is a possible technique for the management of broad-necked cerebral aneurysms. Balloons are currently used to temporarily occlude parent vessels of aneurysms to determine adequacy of collateral flow, as in treatment of carotid ophthalmic artery aneurysms (33). Recently, several studies have demonstrated the efficacy and safety of balloon-assisted GDC (BAGDC) therapy for wide-necked aneurysms or aneurysms with a neck-to-body ratio close to 1 (34-36). GDC therapy presents challenges for interventional radiologists because of the risk of coil migration or coil protrusion into the parent vessel. By using a microcatheter-mounted nondetachable balloon to provide a temporary barrier across the aneurysmal neck, GDCs were deployed safely within a variety of aneurysms, resulting in a 90.9% rate of good-to-excellent clinical outcomes (34). A 100% rate of 95% to 100% aneurysm embolization of wide-necked intracranial aneurysms was reported in another study, with 96% of patients remaining at their preprocedure neurologic baseline (37). It was found that balloon assistance helps by forcing the coil to assume the 3D shape of the aneurysm without impinging on the parent artery, while also stabilizing the microcatheter in the aneurysm during coil delivery (37). BAGDC also allows more-dense intra-aneurysmal coil packing without parent-artery compromise than does the use of GDCs alone (38 ).

As with stent assistance, balloon assistance is associated with several complications that must be resolved. aSAH-induced vasospasm followed by hemorrhagic infarction, as well as several cases of intra-arterial thrombus, has been reported at the site of balloon deployment (37 ), and thromboembolic complication rates of up to 18% have been reported (35). This technique also occasionally results in subtotal or incomplete aneurysmal occlusion, with a correlation between aneurysm size and occlusion rate (36). BAGDC also produces a temporary rise in intra-aneurysmal pressure, a sudden change that might contribute to rupture (39). Furthermore, the technique increases technical complexity, due to the manipulation of a second microcatheter and an inflatable balloon (34).

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