title: Waffle-cone technique with Solitaire™ AB remodeling device: endovascular treatment of highly selected complex cerebral aneurysms.
abstract: BACKGROUND
  To evaluate patients with complex aneurysms who underwent waffle-cone stent-assisted coil embolization.
  
  
  METHODS
  From February 2008 to February 2010, consecutive data were collected from 80 patients with aneurysms treated with the Solitaire™ AB Remodeling Device followed by a standard coiling procedure using bare or/and bioactive coils. Six of these patients were treated using the "waffle-cone-technique" placing the distal end of a stent directly into the base of a bifurcation aneurysm and coiling through the expanded and cone-shaped distal end of the stent allowing for preservation of parent artery patency. The aneurysms were located at the P3 segment of the posterior cerebral artery (n = 1), the middle cerebral artery bifurcation (n = 1), the basilar tip (n = 2), and the AComAnt (n = 2). Four patients underwent follow-up (2-7 months, mean 4.5 months).
  
  
  RESULTS
  Waffle-cone positioning of the Solitaire™ AB Remodeling Device was obtained in all cases without technical problems. No permanent procedural morbidity was observed. In all patients, a Raymond class 2 occlusion was obtained and five patients left the hospital with a good clinical status (mRS0 n = 3, mRS1 n = 1) or no new neurologic deficits (mRS4 n = 1). One patient with SAH III died due to severe vasospasms. Due to major recanalization during follow-up, retreatment was necessary or is planned in four cases; one asymptomatic intimal hyperplasia was observed 8 weeks after initial treatment.
  
  
  CONCLUSIONS
  The waffle-cone technique may enhance the possibilities of the endovascular treatment of these complex aneurysms. Due to the high rate of recanalization requiring endovascular retreatment, stringent angiographic and clinical follow-up is warranted.
authors.affiliation: Department of Diagnostic and Interventional Radiology & Neuroradiology, HELIOS General Hospital Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany.
authors.forename: Vojtech
authors.initials: V
authors.lastname: Sychra
authors.forename: Joachim
authors.initials: J
authors.lastname: Klisch
authors.forename: Maren
authors.initials: M
authors.lastname: Werner
authors.forename: Christian
authors.initials: C
authors.lastname: Dettenborn
authors.forename: Alexander
authors.initials: A
authors.lastname: Petrovitch
authors.forename: Christoph
authors.initials: C
authors.lastname: Strasilla
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Gerlach
authors.forename: Steffen
authors.initials: S
authors.lastname: Rosahl
authors.forename: Markus
authors.initials: M
authors.lastname: Holtmannspötter
mesh_terms: D000328:Adult; D000368:Aged; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015641:Radiography, Interventional / Q000379:methods*; D016896:Treatment Outcome
references.citation: Neurosurgery. 2008 Oct;63(4):662-74; discussion 674-5
references.pmid: 18981877
references.citation: AJNR Am J Neuroradiol. 1999 Mar;20(3):391-9
references.pmid: 10219403
references.citation: AJNR Am J Neuroradiol. 2009 Sep;30(8):1502-6
references.pmid: 19461055
references.citation: Neuroradiology. 2006 Jul;48(7):471-8
references.pmid: 16758153
references.citation: J Neurosurg. 2010 Jun;112(6):1222-6
references.pmid: 19747046
references.citation: Neurosurgery. 1997 Dec;41(6):1235-45; discussion 1245-6
references.pmid: 9402574
references.citation: Neuroradiology. 2010 May;52(5):349-59
references.pmid: 19644683
references.citation: Neurosurgery. 2006 Apr;58(4 Suppl 2):ONS-258-62; discussion ONS-262
references.pmid: 16582648
references.citation: Neurosurgery. 2006 Nov;59(5 Suppl 3):S125-38; discussion S3-13
references.pmid: 17053595
references.citation: Neurosurgery. 2007 Nov;61(5 Suppl 2):249-54; discussion 254-5
references.pmid: 18091239
references.citation: Neuroradiology. 2008 Nov;50(11):909-27
references.pmid: 18802691
references.citation: Clin Neurosurg. 2007;54:64-9
references.pmid: 18504898
references.citation: AJNR Am J Neuroradiol. 2006 Feb;27(2):327-9
references.pmid: 16484403
references.citation: J Neuroimaging. 2010 Jul;20(3):277-9
references.pmid: 19732296
references.citation: AJNR Am J Neuroradiol. 2008 Jan;29(1):73-8
references.pmid: 17928379
references.citation: J Neurosurg. 2009 Jan;110(1):35-9
references.pmid: 18976057
references.citation: Stroke. 1988 Dec;19(12):1497-500
references.pmid: 3201508
references.citation: J Neurosurg. 2005 Feb;102(2):235-41
references.pmid: 15739550
references.citation: Swiss Med Wkly. 2008 Nov 1;138(43-44):646-54
references.pmid: 19005870
references.citation: Stroke. 2010 Jan;41(1):110-5
references.pmid: 19959540
references.citation: J Neurosurg. 2007 Jul;107(1):49-55
references.pmid: 17639873
references.citation: Neuroradiology. 2009 Jun;51(6):411-8
references.pmid: 19277620
references.citation: Neurosurgery. 2009 Aug;65(2):258-66; discussion 266
references.pmid: 19625903
references.citation: Neurosurgery. 2007 Sep;61(3):460-8; discussion 468-9
references.pmid: 17881956
references.citation: AJNR Am J Neuroradiol. 2005 Apr;26(4):862-8
references.pmid: 15814935
references.citation: Interv Neuroradiol. 2003 Dec 20;9(4):391-3
references.pmid: 20591320
references.citation: AJNR Am J Neuroradiol. 2008 Nov;29(10):1959-60
references.pmid: 18719038
references.citation: AJNR Am J Neuroradiol. 2003 Jun-Jul;24(6):1192-9
references.pmid: 12812954
references.citation: AJNR Am J Neuroradiol. 2003 Oct;24(9):1819-22
references.pmid: 14561609
references.citation: Neuroradiology. 2005 Sep;47(9):680-9
references.pmid: 16028036
references.citation: Neuroradiology. 2009 Jun;51(6):419-25
references.pmid: 19322563
references.citation: Neurosurgery. 2009 Nov;65(5):E1007-8; discussion E1008
references.pmid: 19834390
references.citation: Minim Invasive Neurosurg. 2008 Aug;51(4):240-3
references.pmid: 18683119