Sequential sidelong balloon remodeling technique in coil embolization of a wide-necked basilar tip aneurysm

The use of balloon remodeling technique for coil embolization has developed into a safe alternative to stent assisted coil embolization for wide-necked aneurysms. Dual antiplatelet therapy when a stent is placed for assistance in the treatment of ruptured aneurysms is of concern. There are cases in which a single balloon seems insufficient to protect from coil herniation, like when two vessels are in the proximity of the side of the aneurysm neck. Techniques using two balloons for remodeling have been described; however, dual vascular access may be required. A case is presented in which a ruptured basilar tip wide-necked aneurysm was treated with a single balloon, using a sequential sidelong balloon remodeling technique. Complete embolization of the aneurysm was achieved maintaining patency of bilateral posterior cerebral arteries.