Endosurgical Remodeling of Wide-Necked Bifurcation Aneurysms

Endosurgical Remodeling of Wide-Necked Bifurcation Aneurysms

Blog Article

Background: Wide-necked cerebral aneurysms at a bifurcation can be difficult to treat with endovascular techniques despite recent advancements.Objective: We describe a new technique of micro-scaffold remodeling of the aneurysm neck of wide-necked bifurcation aneurysms by placing one or more microcatheters and/or wires in the efferent vessels.We hypothesize that this technique would be a better choice to change the branch angulation, allowing for an improved configuration to stably deploy coils.

We present a retrospective case series to illustrate this technique.Methods: 17 wide-necked bifurcation aneurysms in 17 patients were coil embolized using this technique during a 3 year study period.Branch-vessel microcatheters and/or microwires were used to remodel the aneurysm neck and support the coil Metal Detectors mass.

Statistical analysis of the branch angulation and neck-width changes were performed during treatment.Long-term clinical outcome and follow-up angiography was obtained in 8 patients.Results: Stepdown Transformer Eleven patients had complete occlusion of their aneurysm (Raymond-Roy Class I), and 6 patients had Raymond-Roy Class 2 immediately after treatment.

Efferent vessels demonstrated a statistically significant change in angulation with insertion of microcatheters or microwires, while neck width did not change significantly.There were four intraoperative complications and no neurological morbidity in the immediate post-operative period.Complete occlusion was documented for all 10 subjects with long-term follow-up.

Conclusions: The micro-scaffold endosurgical remodeling technique is a useful adjunct in treating wide-necked bifurcation aneurysms.By elevating branch vessels away from the aneurysm neck, this technique allows for dense coil packing while decreasing the need for balloon or stent assistance.