Preservation of Branching Vessel Using Super Compliant Double-Lumen Balloon Microcatheter: Bulging Neck Plasty Technique and Other Options.

Objective: There are several methods to treat wide-neck aneurysms. We survey the cases that were treated using a super-compliant double-lumen balloon microcatheter (Super-Masamune) for preservation of the branching vessel originating proximal to the aneurysm, especially in the bulging neck plasty (BNP) technique. Methods: We assessed 10 cases in which branching vessel preservation was performed using Super-Masamune. The cases were categorized into three groups: (1) ordinary neck plasty (ONP): balloon microcatheter was navigated to the branch that should be preserved; (2) BNP: another branch was preserved by inflating balloon bulging without cannulation; (3) protection during parent artery occlusion (PPO): the balloon microcatheter was navigated to the vessel to be occluded. The balloon preserves a branch originating near the aneurysm without cannulating to the branch. Results: The aneurysm locations were as follows: internal carotid artery (ICA), three cases; anterior communicating artery (AcomA), one case; basilar artery (BA), three cases; and vertebral artery (VA), three cases. Four cases were ruptured aneurysms, while six cases were unruptured or ruptured in chronic stage. The ONP, BNP, and PPO groups contained two, five, and three cases, respectively. Embolization resulted in complete obliteration in six cases, neck remnant in two cases and body filling in two cases. No rupture/rerupture was noted in this series. One case showed an intraoperative rupture. Conclusion: Super-Masamune is useful for neck plasty, especially BNP, in wide-neck aneurysms. Super-Masamune is also useful for parent artery occlusion when an important branch originates proximal to the aneurysm.