Single-center experience with balloon-assisted coil embolization of intracranial aneurysms: safety, efficacy and indications.
OBJECTIVE
Balloon-assisted coil embolization (BACE) has been widely used for the treatment of intracranial aneurysms. The routine use of this technique remains, however, controversial. In this study, we review our experience with BACE with respect to the indications, complications and effectiveness of the technique.


METHODS
A retrospective review was conducted on 76 BACE procedures performed at a single institution between June 2009 and June 2011.


RESULTS
Of 76 aneurysms (40 ruptured and 36 unruptured) treated with BACE, 64 were located in the anterior circulation and 12 in the posterior circulation. The mean aneurysm size was 6.8mm. A balloon was used for parent vessel protection in 56, side-branch protection in 12 and balloon-in-stent coiling in 8 patients. 75 aneurysms (98.6%) were successfully coiled with a mean packing density of 28.3%. Thromboembolic complications developed after the treatment of 5 aneurysms (6.6%) causing transient morbidity in 4 patients (5.2%). One balloon-unrelated rupture occurred with no significant extravasation due to temporary balloon occlusion. There were no procedure-related permanent morbidity or deaths. 47 patients had imaging follow-up (angiogram in 28, MRA in 19) at a mean timepoint of 7.8 months. 45 patients (95.7%) had complete or near-complete occlusion while 2 patients (4.3%) had major recurrences, one underwent surgical clipping and the other had stent-assisted coiling. One patient had a rehemorrhage (1.3%).


CONCLUSIONS
In our experience, BACE has low complication and recurrence rates in the treatment of complex and wide-necked intracranial aneurysms. High packing densities were achieved with BACE technique.
Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA 19107, USA.
Nohra
N
Chalouhi
Pascal
P
Jabbour
Stavropoula
S
Tjoumakaris
Aaron S
AS
Dumont
Rohan
R
Chitale
Robert H
RH
Rosenwasser
L Fernando
LF
Gonzalez
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000473:pathology / Q000601:surgery; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012008:Recurrence; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult