title: Combination of Multicatheter Plus Stent or Balloon for Treatment of Complex Aneurysms.
abstract: OBJECTIVE
  Coiling of complex aneurysms is still difficult even with current adjuvant techniques. This study sought to evaluate the safety and effectiveness of a combination of multicatheter plus stent or balloon for the treatment of complex aneurysms.
  
  
  METHODS
  All complex aneurysms that underwent coiling with the combination technique were identified from prospectively maintained neurointerventional data bases. "Complex aneurysm" was defined as a wide-neck aneurysm with branch incorporation into or a deep lobulation of the sac. The clinical and angiographic outcomes were retrospectively analyzed.
  
  
  RESULTS
  Sixty-two complex aneurysms (12 ruptured, 50 unruptured) in 62 patients (mean age, 57 years; male/female ratio, 12:50) were treated with a combination technique by using a multicatheter plus stent (n = 42, 3 ruptured) or balloon (n = 20, 9 ruptured). Treatment-related morbidity (grade 3 hemiparesis) occurred in 1 patient (1.6%). Except for 1 patient who had treatment-related morbidity, none of the other patients with unruptured aneurysms developed new neurologic symptoms at discharge. Nine of the 12 patients with ruptured aneurysms had good outcomes (Glasgow Outcome Score, 4 or 5) at the latest follow-up (mean, 32 months; range, 6-72 months), and 1 patient died from an initial SAH. Posttreatment control angiograms revealed complete occlusion in 27, neck remnant in 34, and incomplete occlusion in 1 aneurysm. At least 1 follow-up catheter or MR angiogram was available in 80.6% (n = 50) (mean, 21 months; range, 6-65 months). There were 4 minor and 3 major recurrences (14.0%).
  
  
  CONCLUSIONS
  In this case series, the combination technique by using multicatheter plus stent or balloon seemed safe and effective for the treatment of complex aneurysms.
authors.affiliation: From the Department of Neurosurgery (H.J.J.), Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea.
authors.forename: H J
authors.identifier: http://orcid.org/0000-0002-3968-998X
authors.initials: HJ
authors.lastname: Jeon
authors.affiliation: Departments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.) bmoon21@hanmail.
authors.forename: B M
authors.identifier: http://orcid.org/0000-0001-8593-6841
authors.initials: BM
authors.lastname: Kim
authors.affiliation: Departments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.).
authors.forename: D J
authors.identifier: http://orcid.org/0000-0002-7035-087X
authors.initials: DJ
authors.lastname: Kim
authors.affiliation: Neurosurgery (K.Y.P.), Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: K Y
authors.identifier: http://orcid.org/0000-0002-3254-4577
authors.initials: KY
authors.lastname: Park
authors.affiliation: Departments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.).
authors.forename: J W
authors.identifier: http://orcid.org/0000-0003-3155-0569
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Departments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.).
authors.forename: D I
authors.identifier: http://orcid.org/0000-0001-7527-3829
authors.initials: DI
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D057785:Catheters; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome