Double-balloon trapping technique for embolization of a large wide-necked superior cerebellar artery aneurysm: Case report

OBJECTIVE: To describe a novel double-balloon trapping technique for endovascular embolization of a broad-based saccular aneurysm of the superior cerebellar artery. CLINICAL PRESENTATION: A 62-year-old man with a history of diabetes, coronary artery disease, and smoking presented with a syncopal episode. Catheter angiography revealed a large (11.7 X 9.4 X 11.2 mm) right superior cerebellar artery (SCA) aneurysm with a 7-mm neck, incorporating the origin of the right SCA. INTERVENTION: An endovascular double-balloon trapping technique was used. Using bilateral groin access and bilateral vertebral artery guide catheters, a 4 X 20 mm HyperGlide balloon (ev3 Neurovascular, Irvine, CA) was placed across the neck of the aneurysm, and a 4 X 7 mm HyperForm balloon (ev3 Endovascular Inc., Plymouth, MN) was placed within the aneurysm. The aneurysm was catheterized with an Echelon 14 microcatheter (ev3 Endovascular Inc.). The inflated HyperGlide balloon was used to protect the parent basilar artery and "trap" the smaller HyperForm balloon within the aneurysm. The HyperForm balloon was inflated within the aneurysm and gently retracted to protect the origin of the SCA at the aneurysm neck. The aneurysm was coiled with the balloons inflated. A 4.5 X 20 mm Neuroform stent (Boston Scientific, Natick, MA) was deployed across the aneurysm neck. Final procedural angiography showed near complete occlusion of the aneurysm and preservation of flow in the SCA. Follow-up angiography at 8 months showed progressive thrombosis with complete occlusion of the aneurysm, preserved patency of the SCA, and anatomic reconstruction of the native artery. The patient remained neurologically normal at the time of the follow-up evaluation. CONCLUSION: Double-balloon trapping is a novel endovascular technique that can be used to treat wide-necked aneurysms and maintain patency of side branches incorporated into the aneurysm neck.