gms | German Medical Science

Objective: To prospectively assess short-term, mid-term and long-term results of patients with intracranial aneurysm treated with balloon-assisted coil-embolization on the basis of aneurysm morphology and localization.

Methods: Analysis of all cases featuring balloon-assisted coil-embolization including incidental and ruptured aneurysms since April 2008. Case data collected included demographic data, clinical findings and angiographic results on admission, postinterventionally and during follow-up of up to 18 months. Outcome (Glasgow Outcome Score) was assessed by a neurosurgeon.

Results: To date (March 2010) 242 aneurysms have been treated with coil-embolization, 52 with balloon-assistance. Out of these, 20 patients had incidental aneurysms, 32 had initial subarachnoid hemorrhage (SAH). 38 aneurysms were located in the anterior circulation, 14 in the posterior circulation. 19 were sidewall-aneurysms, 33 were bifurcation-aneurysms (13 centric, 20 excentric). Sidewall-aneurysms and centric bifurcation-aneurysms showed no clinically persistent complications and had good outcome. The sub-group of excentric bifurcation-aneurysms (20 of 52) presented with 6 cases of clinically relevant, procedural complications (thrombosis / vasospasm). In each of those cases the arteries adjacent to the excentric bifurcation-aneurysm had unequal diameters and balloon-placement in the artery bearing the aneurysm was only achieved in 3 of 6 patients.

Conclusions: Balloon-assisted coil-embolization of sidewall-aneurysms and centric bifurcation-aneurysms is technically feasible and midterm angiographic and clinical results present good outcome. Endovascular treatment of excentric bifurcation-aneurysms is technically more challenging and seems to have a potentially higher risk for procedural complications. For this sub-category of intracranial aneurysms neurosurgical treatment might be preferable.