Balloon Remodeling for Treatment of Brain Aneurysms
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Wide necked aneurysms
(in addition to all routine maneuvers for coiling)
a. A minimum lumen of 6 French guide catheter is placed in the cervical vessel.
b-.Place balloon accross neck of aneurysm, balloon is advanced over a micro-wire.
c. The micro-catheter is advanced inside the aneurysm.
d. The balloon is inflated sequentially with every coil. The balloon is deflated after each coil placement to check for the stability of the coil inside the aneurysm.
e . Alternatively the balloon is kept inflated for maximum of 5-7 minutes, while multiple coils are placed.
Can be associated with higher thromboembolic complications than coiling without a balloon, though this is controversial. Additionally, it requires the use of two catheters, one for the coils and the other for the balloon, which adds complexity. Balloon inflation accross acutely ruptured aneurysms may increase the chance for intra-procedural rupture.
May get better packing density and more complete occlusion and may obviate the need for a stent. In addition, the balloon can provide control of the aneurysm (similar to proximal and distal control in the case of clipping), thus, limiting extravasation in the case of intra-procedural rupture.