Balloon-Assisted Rapid Intermittent Sequential Coiling (BRISC) Technique for the Treatment of Complex Wide-Necked Intracranial Aneurysms

Abstract

We describe our experience with balloon-assisted rapid intermittent sequential coiling (BRISC) of complex wide-necked aneurysms as an alternative to stent-assisted coiling. We use this technique in patients with acutely ruptured aneurysms, where antithrombotic treatment prior to stent deployment may not be advisable, and where the vascular anatomy is unfavorable for stenting. This is a retrospective analysis of 11 wide-necked aneurysms treated with this technique from June 2008 to January 2010. Results were analyzed in terms of aneurysm occlusion, procedural complications like thromboembolism, dissection/vasospasm, groin hematoma and any recurrence on follow-up. Coiling was successfully attempted in all cases (100%). Immediate angiographic results showed complete occlusion (class 1) in 8/11, residual neck (class II) in 3/11 and no residual aneurysm (class III). Procedural complications were local thrombus formation in 3/11 procedures but no symptomatic thromboembolism, dissection in 1/11 and groin hematoma in 1/11. There was no morbidity or mortality. On follow-up study, there was one recurrence, which was subsequently coiled. In our opinion, this 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 unsuitable for stenting.