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Updated: Jun 9, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Waffle-cone technique with Solitaire™ AB remodeling device: endovascular treatment of highly selected complex
Vojtech Sychra1, Joachim Klisch, Maren Werner
1Department of Diagnostic and Interventional Radiology & Neuroradiology, HELIOS General Hospital Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany.
Introduction:
To evaluate patients with complex aneurysms who underwent waffle-cone stent-assisted coil embolization.
Methods:
From February 2008 to February 2010, consecutive data were collected from 80 patients with aneurysms treated with the Solitaire™ AB Remodeling Device followed by a standard coiling procedure using bare or/and bioactive coils. Six of these patients were treated using the "waffle-cone-technique" placing the distal end of a stent directly into the base of a bifurcation aneurysm and coiling through the expanded and cone-shaped distal end of the stent allowing for preservation of parent artery patency. The aneurysms were located at the P3 segment of the posterior cerebral artery (n = 1), the middle cerebral artery bifurcation (n = 1), the basilar tip (n = 2), and the AComAnt (n = 2). Four patients underwent follow-up (2-7 months, mean 4.5 months).
Results:
Waffle-cone positioning of the Solitaire™ AB Remodeling Device was obtained in all cases without technical problems. No permanent procedural morbidity was observed. In all patients, a Raymond class 2 occlusion was obtained and five patients left the hospital with a good clinical status (mRS0 n = 3, mRS1 n = 1) or no new neurologic deficits (mRS4 n = 1). One patient with SAH III died due to severe vasospasms. Due to major recanalization during follow-up, retreatment was necessary or is planned in four cases; one asymptomatic intimal hyperplasia was observed 8 weeks after initial treatment.
Conclusion:
The waffle-cone technique may enhance the possibilities of the endovascular treatment of these complex aneurysms. Due to the high rate of recanalization requiring endovascular retreatment, stringent angiographic and clinical follow-up is warranted.
