The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago

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Object. Reports in the literature have offered discussions of the feasibility, efficacy, and safety of balloon-assisted Guglielmi detachable coil (GDC) placement in wide-necked intracranial aneurysms, which was first described by Jacques Moret as the “remodeling technique.” In this article the authors summarize their results in a subset of aneurysms treated with GDCs using the remodeling technique.

Methods. This report contains a retrospective analysis of 72 patients with 75 aneurysms who underwent 79 endovascular procedures performed using the remodeling technique. Morphological outcome was determined at the end of each procedure and by reviewing available follow-up angiograms. Clinical assessments and outcomes are reported using a modified Glasgow Outcome Scale.

Coils were placed in 66 (88%) of 75 aneurysms selected for treatment. In eight aneurysms (11%) treatment failures occurred due to the tortuosity of the vessel used to reach the aneurysms or because of balloon inadequacies.

Incorporating all available follow-up data the authors found that 50 (78%) of 64 aneurysms were completely or subtotally (> 95%) occluded and eight (12%) of 64 were incompletely (< 95%) occluded. Since the time of coil placement, eight aneurysms have progressed to complete occlusion and another five have exhibited progressive thrombosis on follow-up angiograms. In three aneurysms there has been neck remnant growth. Surgical clipping was performed to treat six aneurysms after an initial coil placement procedure. Permanent incidences of morbidity were limited to four patients and there were three deaths directly related to the procedure.

Conclusions. The remodeling technique shows promise in increasing the number of cerebral aneurysms amenable to treatment by endovascular coil placement, and offers an alternative approach to aneurysms that have met with failed surgical treatment or are surgically inaccessible. Long-term follow-up review is needed to determine the final outcome of aneurysms treated by this technique.

Article Information

Address reprint requests to: Victor Aletich, M.D., Department of Neurosurgery, MC 799, University of Illinois at Chicago, 912 South Wood Street, Chicago, Illinois 60612. email: valetich@att.net.

© AANS, except where prohibited by US copyright law.

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Figures

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    Angiograms. A and B: Anteroposterior views of the right (A) and left (B) ICAs, revealing bilateral hypophyseal aneurysms. C and D: Oblique working plane injection of the left ICA following placement of the first coil (C) and immediate posttreatment image demonstrating complete occlusion (D). Note how the coils are flattened at the level of the aneurysm neck caused by balloon inflation during insertion, preventing coil protrusion into the parent artery. E: Anteroposterior view of the right ICA demonstrating complete occlusion of the right hypophyseal aneurysm.

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    Angiograms providing anteroposterior views of left vertebral artery injections. Left: Large irregular basilar tip aneurysm with a wide neck (4 mm). Right: View following GDC placement performed using the remodeling technique with the Endeavor balloon.

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