The “Remodelling Technique” in the Treatment of Wide Neck Intracranial Aneurysms

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Abstract
The main factor limiting endovascular treatment of intracranial aneurysms is the shape of the aneurysmal sac, particularly the width of the neck. In this study we present a new technique to occlude wide neck aneurysms that involve the temporary inflation of a non-detachable balloon in front of the aneurysm neck during each coil placement. The aim of the study is to present the feasibility, efficacy and safety of this “remodelling technique” (RT) compared to that of “normal” GDC treatment. We selected 56 aneurysms in 54 patients for treatment with the RT. Thirty-seven (70%) of the patients presented with subarachnoid haemorrhage. Twenty-five (45%) of the aneurysms were located at the vertebrobasilar artery, 24 (43%) at the internal carotid artery, and seven at the level of smaller arteries. Treatment was achieved in 52 aneurysms in 50 patients. Two aneurysms which were initially not completely occluded underwent a second treatment using the RT. Final results (i.e. the last follow-up angiography or results at the end of the treatment for the cases that have not yet had follow-up) consisted of total occlusion in 40 cases (77%), subtotal occlusion in nine cases (17%), and incomplete occlusion in three cases (6%). Angiographic evidence of clotting was observed during the procedure in three cases, resulting in one permanent deficit (quadranopia). Rupture of the aneurysmal sac occurred during the procedure in three cases, all of which were asymptomatic in the follow-up. Thus, morbidity due to the technique was 1/52 (1%) and mortality was 0/56 patients. The remodelling technique allowed the treatment of 52 wide neck or badly shaped aneurysms that were not treatable without this technique. The results of occlusion with the RT seem better than those in our series of normal GDC treatment, and complications related to the technique are fewer. This technique thereby extends the spectrum of treatable aneurysms without increasing the risk incurred by treatment.