title: A novel neck-sealing balloon technique for distal access through a giant aneurysm.
abstract: BACKGROUND
  In endovascular treatment for cerebral aneurysms using balloons, stents, or flow diverters, a microguidewire or microcatheter needs to be navigated distally across the neck of the aneurysm. However, this is sometimes difficult when there is a wide-neck or large aneurysm with a tortuous or atherosclerotic parent vessel. In this case report, we describe a new technique for navigating a microcatheter into a distal vessel.
  
  
  METHODS
  An 81-year-old woman presented with trigeminal neuralgia and diplopia due to abducens nerve palsy because of a giant cavernous carotid artery aneurysm. We planned stent-assisted coil embolization of the aneurysm and tried to advance a microcatheter into a distal vessel across the neck of the aneurysm. Although we attempted several previously reported techniques, these were unsuccessful. We then navigated a balloon into the aneurysm, slowly inflated it within the aneurysm, pulled it back gently, and sealed the neck orifice of the aneurysm with the balloon. We easily navigated a microcatheter into the distal vessel. The stent-assisted coil embolization was completed with no complications.
  
  
  CONCLUSIONS
  This novel neck-sealing technique with a balloon for distal access may be useful in cases in which other methods are unsuccessful. In addition, this technique offers the advantages of not producing a loop in the microcatheter within an aneurysm and not requiring retraction of the microcatheter to reduce the loop.
authors.affiliation: Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kono
authors.forename: Hideo
authors.initials: H
authors.lastname: Okada
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Terada
mesh_terms: D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods*; D001807:Blood Vessel Prosthesis; D002340:Carotid Artery Diseases / Q000150:complications / Q000628:therapy*; D002533:Cerebral Angiography; D004172:Diplopia / Q000209:etiology; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D009333:Neck; D014277:Trigeminal Neuralgia / Q000209:etiology / Q000628:therapy