Intraaneurysmal Neck Plasty: Efficacy of a Super Compliant Double-Lumen Balloon Microcatheter

OBJECTIVE: While wide-neck aneurysms can be treated with several methods, we report the specific technique of intraaneurysmal neck plasty (IANP) with a super compliant double-lumen balloon microcatheter (Super-Masamune). METHODS: The Super-Masamune was inflated inside 18 aneurysms. Cases in which the tip of the Super-Masamune was located in the aneurysm were included. Embolization methods were the same as those used in the application of other balloons/stents. The use of the Super-Masamune for the performance of IANP followed two patterns: (1) the Super-Masamune was used not only as a balloon but also for coil insertion (simple IANP); (2) the Super-Masamune was used only as a balloon, and a microcatheter for coil insertion was separately introduced coaxially (coaxial IANP). RESULTS: The aneurysms were located in the anterior communicating artery (n = 6), middle cerebral artery (MCA; n = 4), anterior cerebral artery (n = 1), internal carotid artery (n = 5), basilar artery (n = 1), and vertebral artery (n = 1). Eight of the aneurysms were ruptured, while 10 were unruptured. Simple and coaxial IANP were both performed in seven cases. Embolization was not performed after inflating the Super-Masamune inside the aneurysm in four cases. Embolization grades following the procedure included eight neck remnants (NRs) and six body fillings (BFs). There was one complication of intraoperative rerupture; however, there was no rupture/rerupture in the follow-up period. Retreatment of the target aneurysm was performed in two cases. The embolization grade assessed in the follow-up period reached complete occlusion for one patient, NR for five, and BF for two patients. CONCLUSION: IANP using the Super-Masamune is useful for the treatment of wide-neck aneurysms in which the introduction of a guidewire and/or microcatheter into the branching artery is difficult.