Temporary balloon protection as an adjunct to endosaccular coiling of wide-necked cerebral aneurysms: Technical note

OBJECTIVE: We present an endovascular technique for treating wide- necked cerebral aneurysms using Guglielmi detachable coils (Target Therapeutics, Fremont, CA) and simultaneous temporary balloon protection. The temporary balloon serves as a mechanical external force to mold the microcoils away from the parent artery. METHODS: Two illustrative cases of wide-necked cerebral aneurysms treated with Guglielmi detachable coils and a temporary balloon are presented. Emphasis is placed on the technical aspects of the approach, with several variations. The first case involves a left posterior cerebral artery aneurysm at the P1/P2 segment, and the second case involves a left paraclinoid internal carotid artery aneurysm. Both patients suffered from subarachnoid hemorrhage, but neither was a candidate for craniotomy. In each case, the coils, when used alone, protruded into the parent artery and were therefore removed. Then a temporary balloon was inflated for mechanical protection during coil deployment. RESULTS: The use of simultaneous temporary balloon protection allowed more dense intra- aneurysmal coil packing, especially in the neck, without parent artery compromise, than did the use of Guglielmi detachable coils alone. CONCLUSION: Endovascular treatment of wide-necked cerebral aneurysms can be facilitated by simultaneous temporary balloon protection.