Intracranial aneurysms: interventional neurovascular treatment with detachable balloons--results in 215 cases

Article Abstract:

Intracranial aneurysms are abnormal dilations in the blood vessels of the brain. They are often caused by blood clots and atherosclerotic disease, and are dangerous because they are areas of weakness that are prone to bursting, causing hemorrhage that can be fatal. Some cases can be treated surgically, but others cannot. Treatments involving inserting a catheter with a microballoon that can be inflated into the vessel to remove or fill the aneurysm have been developed and used recently. This study examines the results of treatment with one of these techniques, intravascular detachable balloon embolization. This procedure involves inserting a balloon into the aneurysm, inflating it to fill up the aneurysm, exchanging the contrasting agent in the balloon with a substance that fills the aneurysm and solidifies, and detaching the balloon. The results are described from 215 intracranial aneurysms in 211 patients treated with this technique. The patients were divided into two treatment groups, 127 cases which required treatment of the parent vessel and 88 cases in which direct treatment of the aneurysm could be accomplished. In the first group, there were seven strokes (5.5 percent) and five deaths (3.9 percent). Follow-up in this group showed clinical improvement and decreased aneurysm size in 115 of the patients treated. In the group treated directly in the aneurysm, there were 16 deaths (18.2 percent) and nine strokes (10.2 percent). Follow-up in these patients showed continued aneurysm occlusion (it remained filled up) in 66 of the patients (75 percent). These results indicate that this technique is useful for treating aneurysms in patients who either cannot have surgery, or in whom surgery is unsuccessful. Although direct treatment of the aneurysm had a high mortality and morbidity rate, it is a useful alternative when other treatments cannot be performed or pose a greater risk. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Prevention

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Intracranial aneurysms: interventional neurovascular treatment with detachable balloons

Article Abstract:

Treatments for intracranial aneurysms (abnormally dilated blood vessels in the brain, usually caused by clots) have improved greatly since simple clips were applied to the aneurysm in the 1940s. Surgical techniques for treating these aneurysms have become highly sophisticated and successful. Vasospasm, spasmodic movements in the vessels, remains a complication of treatment of aneurysms. New drugs are being developed to combat this problem. A major difficulty in treating aneurysms is that some are located in places that are not accessible for surgery to be performed. An article in this issue by Higashida and colleagues examines using balloon catheters to treat aneurysms. Their study is encouraging regarding treatment with this technique, however it is important to note that surgery may be preferable when it is an option. Surgery can directly remove blood clots in the area of the aneurysm. If the aneurysm ruptures during treatment, the patient may be saved if it occurs during surgery, but this is highly unlikely if the patient is being treated with a balloon catheter. The article does not address vasospasm as a complication, or the timing of when the procedure should be performed. A combination of the two techniques, surgery and balloon catheterization, might be a further advance in the future for treating intracranial aneurysms. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, editorial

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