Balloon-Assisted Guglielmi Detachable Coil Placement in Wide-Necked Internal Carotid-Ophthalmic Aneurysms: A Report of Four Cases

Abstract

We present an endovascular technique for treating wide-necked ophthalmic aneurysms using Guglielmi detachable coils with simultaneous temporary balloon protection. Four illustrative cases of wide-necked ophthalmic aneurysms treated with Guglielmi detachable coils and a temporary balloon are presented. By blocking the parent artery with a non-detachable balloon, the coils could be safely placed in these aneurysms without herniation when the balloon was deflated. All patients exhibited embolic manifestations after the procedure, and the use of simultaneous temporary balloon protection allowed more dense intra-aneurysmal coil packing. Although this technique requires manipulation of a second microcatheter and balloon, which increases its technical difficulties and is a higher-risk procedure than the standard coil placement, it can be used for patients who are not candidates for surgery. Long-term follow-up is needed to determine the final outcome of aneurysms treated by this technique.

Internal Carotid - Ophthalmic Aneurysm - Wide-Neck - Embolization - Electrically Detachable Coil

References

• 1 Aletich V A, Debrun G M, Misra M, Charbel F, Ausman J I. The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago.  J Neurosurg. 2000;  93 388-396
• 2 Almeida G M, Shibata M N, Bianco E. Carotid ophthalmic aneurysms.  Surg Neurol. 1976;  5 4-15
• 3 Aymad A, Gobin V P, Hodges J E. Endovascular occlusion for vertebral arteries in the treatment of unclippable vertebro-basilar aneurysms.  J Neurosurg. 1991;  74 393-398
• 4 Benedetti A, Carri P. Direct attack in carotid ophthalmic and large internal carotid aneurysm.  Surg Neurol. 1977;  8 49-54
• 5 Casasco A E, Aymard A, Gobin P, Houdart E, Rogopoulos A, George B, Hodes J E, Cophignon J, Merland J J. Selective endovascular treatment of 71 intracranial aneurysms with platinum coils.  J Neurosurg. 1993;  79 3-10
• 6 Debrun G M, Aletich V A, Kehrli P. et al . Selection of cerebral aneurysms for treatment using Guglielmi detachable coils. The preliminary University of Illinois at Chicago experience.  Neurosurgery. 1998;  43 1281-1297
• 7 Guglielmi G, Vinuela F, Dion J, Duckwire G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience.  J Neurosurg. 1991;  75 8-14
• 8 Guglielmi G, Vinuela F, Duckwiler G, Dion J, Lylyk P, Berenstein A, Strother C, Graves V, Halbach V, Nivhols D, Hopkins N, Ferguson R, Sepetka I. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils.  J Neurosurg. 1992;  77 515-524
• 9 Guidetti B, La Torre E. Management of carotid-ophthalmic aneurysms.  J Neurosurg. 1975;  42 438-442
• 10 Levy D I, Ku A. Balloon-assisted coil placement in wide-necked aneurysms. Technical note.  J Neurosurg. 1997;  86 724-727
• 11 Mericle R A, Wakhloo A K, Rodriguez R. et al . Temporary balloon protection as an adjunct to endovascular coiling of wide-necked cerebral aneurysms: technical note.  Neurosurgery. 1997;  41 975-978
• 12 Moret J, Cognard C, Weil A, Castaings L, Rey A. The remodeling technique in the treatment of wide-necked intracranial aneurysms: angiographic results and clinical follow-up in 58 cases.  Intervent Neuroradiol. 1997;  3 21-35
• 13 Nakao S, Kikuchi H, Takahashi N. Successful clipping of carotid-ophthalmic aneurysms through a contralateral pterional approach: Report of two cases.  J Neurosurg. 1981;  54 532-536
• 14 Romodinov A P, Shcheglov V I. Advances and Technical Standards in Neurosurgery. New York, Wien: Springer vol 9 1982: 25-48