Balloon-assisted coil embolization (BACE) has become an important adjunct in the endovascular treatment of wide neck intracranial aneurysms. The management of broad-necked cerebral aneurysms is technically very perplex due to a variety of factors, which include difficulty in defining the aneurysm/parent vessel interface angiographically and problems in achieving complete aneurysmal occlusion which could later predispose to regrowth or recanalization of the aneurysm. We sought to determine safety and efficacy of TransForm™ Occlusion Balloon Catheter (TOBC) for coiling of broad-necked intracranial aneurysms at our institute.Materials and methods
Seventy-four aneurysms were treated from March 2012 to March 6th 2014 by balloon remodeling technique. In fifty-three/seventy-four (72%) patients balloon was prepped and in Forty-four/seventy-four (59%) aneurysm required balloon assistance for coil embolization as they were characterised by wide necks or were small with unfavorable neck/fundus ratios.Results
TOBC balloon was used in 18/44 (41%) of the cases to treat 18 aneurysms in 16 patients. In 1 patient TOBC was used to treat vasospasm. 11/19(25%) were ruptured aneurysms with 4 of which had ventriculostomy. Stent was used in 4/19 cases. Stent was used as bailout in 2 cases to support coils from herniating into parent vessel after balloon deflation while in the other 2 cases stent was preplanned. Maximum balloon inflation time per inflation in 19 cases ranged from 1–4 min. Aneurysm size ranged from 2.3 mm to 20.2 mm with average size of 7.17 mm. Neck diameter treated measured from 1.45 mm to 10 mm with and average neck diameter of 3.54 mm.Results
Average balloon preparation time was 3.8 min. In 18/18 (100%) aneurysms, balloon was been able to track to the intended site. 2/18 (11%) had watermelon seeding effect on inflating the balloon and in 16/18 (89%) balloons remained stable during inflation and deflation.Results
Thrombus developed in 2/19 (10.5%) cases (1 ruptured and 1 un-ruptured) at the neck of the aneurysm both causing partial occlusion. In both cases thrombus resolved completely with IIb/IIIa inhibitors. Vessel perforation occurred 0/44 (0%). Perforation by coil or microcatheter occurred in 0/19 (0%); Dissection 0/19 (0%) and stroke related to thrombus formation occurred in 0/19 (0%) of cases. Complete obliteration (class I) was achieved In 14/18 (78%) cases while in 3/19 (17%) cases residual neck/dog ear (class II) were left intentionally to keep branches open at the neck. In 1/18 (5%) complete obliteration could not be obtained due to inability to fill the residual space with coils.Conclusions
In our single-center study, balloon remodeled coil embolization of aneurysm using TOBC was not associated with any serious complications. The balloon was trackable to intended site and the preparation time was relatively short. We believe that TOBC has good utility in treating broad-necked aneurysms and small aneurysms that are otherwise suboptimally managed by conventional deployment.Disclosures
S. Quadri: None. V. Ramakrishnan: None. A. Sodhi: None. V. Cortez: None. M. Taqi: None.