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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.00245

ENDOSURGICAL REMODELING OF WIDE-NECKED BIFURCATION ANEURYSMS

  • 1Baylor Scott and White Health, United States
  • 2Doctors Hospital at Renaissance, United States

Background: Wide-necked cerebral aneurysms at a bifurcation can be difficult to treat with endovascular techniques despite recent advancements.
Objective: We describe a new technique of micro-scaffold remodeling of the aneurysm neck of wide-necked bifurcation aneurysms by placing one or more microcatheters and/or wires in the efferent vessels. We hypothesize that these devices change the branch angulation, allowing for an improved configuration to stably deploy coils. We present a retrospective case series to illustrate this technique.
Methods: 17 wide-necked bifurcation aneurysms in 17 patients were coil embolized using this technique during a 3 year study period. Branch-vessel microcatheters and/or microwires were used to remodel the aneurysm neck and to support the coil mass. Statistical analysis of the branch angulation and neck-width changes during treatment was performed. Long-term clinical outcome and follow-up angiography was obtained in 8 patients.
Results: Eleven patients had complete occlusion of their aneurysm (Raymond-Roy Class I), and 6 patients had Raymond-Roy Class 2 immediately after treatment. Efferent vessels demonstrated a statistically significant change in angulation with insertion of microcatheters or microwires while neck width did not change significantly. There were four intraoperative complications and no neurological morbidity in the immediate post-operative period. Complete occlusion was documented for all 10 subjects with long-term follow-up.
Conclusions: The micro-scaffold endosurgical remodeling technique is a useful adjunct in treating wide-necked bifurcation aneurysms. By elevating branch vessels away from the aneurysm neck, this technique allows for dense coil packing while decreasing the need for balloon or stent assistance.

Keywords: Coil embolization, Wide-necked aneurysms, bifurcation aneurysms, Endosurgical remodeling, Micro-scaffolding

Received: 01 Jul 2018; Accepted: 25 Feb 2019.

Edited by:

Afshin A. Divani, University of Minnesota Twin Cities, United States

Reviewed by:

Min S. Park, University of Virginia Hospital, United States
Saurav Das, University of Louisville, United States
John Cox, Medical College of Wisconsin, United States  

Copyright: © 2019 Dayawansa, Sulhan, Huang and Noonan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Jason H. Huang, Baylor Scott and White Health, Temple, United States, jason.huang@bswhealth.org