Balloon assistance as a routine adjunct to the endovascular treatment of cerebral aneurysms

The technique of BAC is attractive because the balloon theoretically allows for (1) "control" of blood flow in the vessel; (2) improved stability of the microcatheter in the aneurysm; (3) denser packing with coils; and (4) improved delineation of the neck of the aneurysm. The purpose of this communication is to document our outcomes with this technique and help determine if this technique is of benefit.

Data on all endovascularily treated aneurysms have been gathered prospectively at our institution since March 2000. The first case of BAC was in November 2000. We have become very liberal in our indications, to the point where all aneurysms are considered for BAC. We document here our results obtained over a 1-year period, during which we treated 56 patients with 60 aneurysms in 58 coiling sessions using only bare platinum coils.

Balloon-assisted coiling was attempted in 50 (86%) of the 58 coiling sessions. Successful embolizations were achieved in all but 1 patient in whom BAC was attempted. There was one technique-related complication. The packing density for the BAC cases was, on average, 35.7% (median, 34.6%; SD, 14.1%). Follow-up angiography revealed a 13% class 3 recurrence rate.

With experience, BAC can be used in the endovascular treatment of most cerebral aneurysms. Although complications are associated with its use, we feel that the risk/benefit ratio is favorable. Excellent coil packing density with bare coils is achievable with this technique.