Balloon remodeling technique (BRT) [Neurosurgery Wiki]

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=====Balloon remodeling technique (BRT)=====
Remodeling technique and stenting represent important options for [[intracranial aneurysm]] treatment, and they sometimes need to be combined. 

The 'balloon-then-stent' method involves stent placement after completion of a balloon-assisted embolization.

The drawback to this technique is that the coil mass achieved during balloon remodeling must be crossed prior to stent deployment. This additional maneuver introduces the potential risk of coil disruption.

The technology of remodeling balloons and stents has evolved with the development of the double-lumen remodeling balloon (Scepter and Ascent) and the low-profile stent (LVIS Jr).

Primary BRT followed by [[stent-assisted coiling]] may be associated with fewer residual [[aneurysm]]s at 12 to 18 months as compared to stent-assisted coiling alone
((Gentric JC, Biondi A, Piotin M, Mounayer C, Lobotesis K, Bonafé A, Costalat V.
Balloon remodeling may improve angiographic results of stent-assisted coiling of 
unruptured intracranial aneurysms. Neurosurgery. 2015 Apr;76(4):441-5. doi:
10.1227/NEU.0000000000000639. PubMed PMID: 25621980.
)).

The use of balloons in the field of neurosurgery is currently an essential part of our clinical practice. The field has evolved over the last 40 years since Serbinenko used balloons to test the feasibility of occluding cervical vessels for intracranial pathologies. Since that time, indications have expanded to include sacrificing cervical and intracranial vessels with detachable balloons, supporting the coil mass in wide-necked aneurysms (balloon remodeling technique), and performing intracranial and cervical angioplasty for atherosclerotic disease, as well as an adjunct to treat arteriovenous malformations. With the rapid expansion of endovascular technologies, it appears that the indications and uses for balloons will continue to expand ((Alaraj A, Wallace A, Dashti R, Patel P, Aletich V. Balloons in endovascular
neurosurgery: history and current applications. Neurosurgery. 2014 Feb;74 Suppl
1:S163-90. doi: 10.1227/NEU.0000000000000220. PubMed PMID: 24402485.
)).
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Delgado Acosta et al. aimed to report the characteristics of patients suffering intra- or peri-procedural ruptures during [[embolization]] of [[cerebral aneurysm]]s.

Between March [[1994]] and October [[2021]], 648 consecutive [[cerebral aneurysm]]s were treated by the [[endovascular]] [[procedure]]. [[Medical record]]s were [[review]]ed [[retrospective]]ly with emphasis on procedure description, potential [[risk factor]]s, and [[clinical outcome]]s related to intra- or peri-procedural rupture.

Of the 648 patients, 17 (2.6%) suffered an intra- or peri-procedural hemorrhagic event. The most common location was the [[anterior communicating artery]]. There was no significant difference between previously ruptured and [[unruptured aneurysm]]s in the incidence of [[bleeding]]. In four patients, bleeding was evident within 24 h after the procedure. The clinical evolution at three months was poor and only four patients presented a positive evolution. There were 11 deaths (64.71%). [[Balloon remodeling]] was associated with an increased frequency of ruptures, while [[stenting]] was a safer treatment.

[[Aneurysm rupture]] during [[endovascular therapy]] is unpredictable, and its occurrence can be devastating. The incidence is quite low although the outcome is frequently poor. Early detection and proper management, including prompt occlusion of the aneurysm, are important to achieve a positive outcome. [[Anterior communicating artery aneurysm]]s and those treated with [[balloon catheter]]s have a higher incidence of rupture. A small number of ruptures of uncertain origin occur that go unnoticed in digital subtraction angiograms
((Delgado Acosta F, Bravo Rey I, Jiménez Gómez E, Saucedo VR, Toledano A, Oteros Fernández R. Intra- or peri-procedural rupture in the endovascular treatment of intracranial aneurysms. Acta Neurol Scand. 2022 Aug 17. doi: 10.1111/ane.13686. Epub ahead of print. PMID: 35975464.)).