Balloon-assisted coil placement in wide-necked aneurysms. Technical note

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Saccular intracranial aneurysms are a significant cause of morbidity and mortality.
• Surgical intervention is the gold standard, but not always feasible.
• Electrolytically detachable coils offer an alternative to medical management alone.

Observation:

• Two cases of ophthalmic artery aneurysms with wide necks presented challenges for standard Guglielmi detachable coil placement.
• Aneurysms measured 7 mm and 4 mm, with wide neck-to-sac ratios.
• Initial attempts at coil embolization were unsuccessful due to coil herniation risk.

Findings:

• A balloon-assisted technique, involving temporary parent artery occlusion with a nondetachable balloon, enabled safe coil placement.
• Coils were successfully deployed without herniation once the balloon was deflated.
• Both patients experienced embolic symptoms post-procedure, with one resulting in a mild permanent deficit.

Implications:

• This technique provides a viable option for complex wide-necked aneurysms in patients unsuitable for surgery.
• It increases technical difficulty and procedural risk compared to standard coiling.
• Further research may refine this technique for broader application in challenging aneurysm cases.