Mayank Goyal MD, Presenter: Nothing to Disclose

Jayesh Ashok Modi MD, Abstract Co-Author: Nothing to Disclose

Muneer Eesa MBBS, Abstract Co-Author: Nothing to Disclose

John H. Wong MD, Abstract Co-Author: Nothing to Disclose

William Morrish MD, Abstract Co-Author: Nothing to Disclose

Mark Hudon MD, Abstract Co-Author: Nothing to Disclose

We describe a new technique of balloon-assisted rapid intermittent sequential coiling (BRISC) as an alternative to stent-assisted coiling in patients with ruptured wide-necked aneurysm where antithrombotic treatment prior to stent deployment may not be advisable in acute subarachnoid hemorrhage (SAH) and in unfavorable vascular anatomy where the parent vessel is too small for a stent.

We analyzed 8 patients treated with balloon-assisted rapid intermittent sequential coiling for wide-necked aneurysms from October 2008 to March 2009. In BRISC technique, multiple coils (usually 3-5 coils) were rapidly deployed in aneurysm while maintaining balloon inflation for a maximum duration of 5 minutes. The balloon would then be deflated for 5 minutes to allow reperfusion to occur. This cycle would be repeated as necessary to achieve final coil packing within the aneurysm. Results were analyzed in terms of aneurysm occlusion, coil stability and thromboembolic complications.

8 aneurysms were treated with balloon-assisted coiling. Stent was not used in 4 ruptured aneurysms to avoid use of antiplatelets. Out of 4 unruptured aneurysms, in 3 patients vessel diameter was too small for stent deployment and 1 patient was allergic to clopidogrel. BRISC technique was used as the first coil was felt to be unstable after balloon deflation and was prolapsing back in the parent vessel. With BRISC technique, 5/8 were completely occluded. 3/8 were near-total occlusion with small remnant. Stent-assisted coiling was later performed for a small remnant in one patient when the acute SAH phase subsided. In other 2 patients, small remnant was coiled in second sitting. There were no major thromboembolic complications. Follow-up at 6 to 12 months showed stable coil mass within the aneurysm.

BRISC technique allowed a good packing of aneurysm by multiple, rapidly detached coils per balloon inflation cycle and affording a stable configuration across the wide-necked aneurysm. BRISC technique may provide an alternative to stent-assisted coiling in patients with ruptured aneurysm where antithrombotic treatment prior to stent deployment may not be advisable and in the presence of vascular anatomy not suitable for stenting.

BRISC technique may provide an alternative to stent-assisted coiling in patients with ruptured aneurysm and in the presence of vascular anatomy not suitable for stenting.

Goyal, M, Modi, J, Eesa, M, Wong, J, Morrish, W, Hudon, M, Balloon-assisted Rapid Intermittent Sequential Coiling (BRISC) Technique for Treatment of Complex Wide-Necked Intracranial Aneurysms.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9007275.html