Dual-Lumen Balloon-Assisted Coiling and Staged Flow Diversion for Ruptured Wide-Necked Posterior Communicating Artery Aneurysm: Two-Dimensional Operative Video

Endovascular treatment of acutely ruptured wide-necked aneurysms presents well-known challenges because of the desire to avoid intracranial stenting with attendant dual antiplatelet therapy requirements. Balloon-assisted coiling (BAC) has been well described for this purpose, most commonly using a 2-microcatheter technique, with a balloon microcatheter protecting the aneurysm neck and a coiling microcatheter used to embolize the aneurysm.1,2 However, the availability of advanced double-lumen balloon microcatheters with coiling markers allows for the use of a single-microcatheter technique in select instances.3 We present the case of a patient presenting with a ruptured wide-necked posterior communicating artery aneurysm with a large posterior communicating artery arising from the neck. The aneurysm dome had sufficient height to allow BAC using a single balloon microcatheter, which was used to protect the posterior communicating artery at the neck and deploy coils in the aneurysm dome. The aneurysm was intentionally subtotally coiled and the patient was retreated with a flow-diverting stent later during the same hospitalization (Video 1). Partial coiling followed by later flow diversion is a pragmatic strategy in wide-necked ruptured aneurysms,4 and use of a single balloon microcatheter for BAC can be useful in certain situations.