Balloon-assisted Catheterization Technique under Proximal Flow Control with Balloon Guiding Catheter in Endovascular Treatment of Cerebral Aneurysm

[Objective] : A compliant balloon microcatheter has been used conventionally to perform remodeling in the treatment of broad-neck intracranial aneurysms. We describe a balloon-assisted microcatheterization technique using a compliant balloon microcatheter under proximal flow control of a balloon guiding catheter for the purpose of microcatheter navigation into aneurysms with anatomical difficulty. [Case Presentations] : We used this technique successfully in six patients who had non-ruptured paraclinoid aneurysms. A balloon guiding catheter is placed in the parent artery. A compliant balloon catheter is navigated to distal to the aneurysmal neck for occlusion of the distal route. After inflating the balloon of the guiding catheter, the compliant balloon is inflated. The distal balloon creates a barrier, and only the path to the aneurysm remains. Balloon inflation of the guiding catheter is helpful to stabilize a distal compliant balloon so that the balloon does not float. In addition, proximal flow control of the parent artery may prevent blood pressure from increasing inside the aneurysm and leading to aneurysm rupture when a compliant balloon is inflated distal to the aneurysmal neck. [Conclusion] : If catheter detention to an aneurysm in coil embolization is anatomically hazardous, this method is easy, safe, and very useful, and an important option.