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Combination of Multicatheter Plus Stent or Balloon for Treatment of Complex Aneurysms
1From the Department of Neurosurgery (H.J.J.), Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea.
Insights
This study shows that combining multicatheter techniques with stents or balloons is a safe and effective treatment for complex brain aneurysms, improving patient outcomes.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Coiling complex aneurysms remains challenging despite current adjuvant techniques.
- Complex aneurysms are defined by wide necks, branch incorporation, or deep sac lobulation.
Purpose of the Study:
- To evaluate the safety and effectiveness of a combined multicatheter plus stent or balloon technique for treating complex aneurysms.
- To assess clinical and angiographic outcomes in patients undergoing this combined treatment.
Main Methods:
- Retrospective analysis of prospectively maintained neurointerventional databases.
- Inclusion criteria: complex aneurysms treated with multicatheter plus stent or balloon.
- Definition of complex aneurysm: wide-neck with branch incorporation or deep lobulation.
Main Results:
- Sixty-two complex aneurysms (12 ruptured, 50 unruptured) were treated.
- Low treatment-related morbidity (1.6%) and good outcomes for ruptured aneurysm patients.
- Angiographic follow-up showed complete occlusion in 27 aneurysms and neck remnants in 34; 14.0% recurrence rate.
Conclusions:
- The combination technique using multicatheter plus stent or balloon appears safe and effective for complex aneurysms.
- This approach offers a viable option for challenging aneurysm cases.
Background And Purpose:
Coiling of complex aneurysms is still difficult even with current adjuvant techniques. This study sought to evaluate the safety and effectiveness of a combination of multicatheter plus stent or balloon for the treatment of complex aneurysms.
Materials And Methods:
All complex aneurysms that underwent coiling with the combination technique were identified from prospectively maintained neurointerventional data bases. "Complex aneurysm" was defined as a wide-neck aneurysm with branch incorporation into or a deep lobulation of the sac. The clinical and angiographic outcomes were retrospectively analyzed.
Results:
Sixty-two complex aneurysms (12 ruptured, 50 unruptured) in 62 patients (mean age, 57 years; male/female ratio, 12:50) were treated with a combination technique by using a multicatheter plus stent (n = 42, 3 ruptured) or balloon (n = 20, 9 ruptured). Treatment-related morbidity (grade 3 hemiparesis) occurred in 1 patient (1.6%). Except for 1 patient who had treatment-related morbidity, none of the other patients with unruptured aneurysms developed new neurologic symptoms at discharge. Nine of the 12 patients with ruptured aneurysms had good outcomes (Glasgow Outcome Score, 4 or 5) at the latest follow-up (mean, 32 months; range, 6-72 months), and 1 patient died from an initial SAH. Posttreatment control angiograms revealed complete occlusion in 27, neck remnant in 34, and incomplete occlusion in 1 aneurysm. At least 1 follow-up catheter or MR angiogram was available in 80.6% (n = 50) (mean, 21 months; range, 6-65 months). There were 4 minor and 3 major recurrences (14.0%).
Conclusions:
In this case series, the combination technique by using multicatheter plus stent or balloon seemed safe and effective for the treatment of complex aneurysms.
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