Endovascular Treatment of Unruptured Intracranial Aneurysms: Comparison of Safety of Remodeling Technique and Standard Treatment with Coils

Purpose: To analyze the safety of the remodeling technique compared with the safety of the standard treatment with coils for endovascular treatment of unruptured intracranial aneurysms in a large multicenter series of patients as part of the Analysis of Treatment by Endovascular Approach of Nonruptured Aneurysms (ATENA) study.

Materials and Methods: The medical ethics committee approved the ATENA study, and all patients gave informed consent for participation in the study. The ATENA study was performed in 27 institutions. For each patient group, we recorded aneurysm characteristics, rate of adverse events related to the treatment, and patient outcome.

Results: In this study, 547 patients (383 women, 164 men; mean age, 51.0 years ± 11.1 [standard deviation]; range, 22–83 years) with 572 aneurysms were included; 325 patients were treated with coils alone and 222 patients were treated with the remodeling technique. The overall rate of adverse events related to the treatment—regardless of whether the adverse events led to clinical consequences—was 10.8% (35 of 325) for treatment with coils alone and 11.7% (26 of 222) for the remodeling technique. Thromboembolic events, intraoperative rupture, and device-related problems were encountered in 20 (6.2%), seven (2.2%), and eight (2.5%) of 325 patients in the standard treatment group and in 12 (5.4%), seven (3.2%), and seven (3.2%) of 222 patients in the remodeling technique group, respectively. The morbidity and mortality rates did not differ significantly between groups: 2.2% (seven of 325) and 0.9% (three of 325) in the standard treatment group and 2.3% (five of 222) and 1.4% (three of 222) in the remodeling technique group, respectively.

Conclusion: The remodeling technique was associated with a similar rate of adverse events and morbidity and mortality combined compared with the standard treatment with coils, and, thus, the remodeling technique is as safe as the standard treatment with coils.

© RSNA, 2009


  • 1 Molyneux A, Kerr R, Stratton I, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002; 360: 1267–1274. Crossref, MedlineGoogle Scholar
  • 2 Moret J, Pierot L, Boulin A, Castaings L. “Remodelling” technique of the arterial wall in the endovascular treatment of intracranial aneurysms [abstr]. Neuroradiology 1994; 36(suppl 1): S83. CrossrefGoogle Scholar
  • 3 Moret J, Cognard C, Weill A, Castaings L, Rey A. The “remodelling technique” in the treatment of wide neck intracranial aneurysms. Intervent Neuroradiol 1997; 3: 21–35. Crossref, MedlineGoogle Scholar
  • 4 Aletich VA, Debrun GM, Misra M, Charbel F, Ausman JI. The remodeling technique of balloon assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago. J Neurosurg 2000; 93: 388–396. Crossref, MedlineGoogle Scholar
  • 5 Cottier JP, Pasco A, Gallas S, et al. Utility of balloon-assisted Guglielmi detachable coiling in the treatment of 49 cerebral aneurysms: a retrospective, multicenter study. AJNR Am J Neuroradiol 2001; 22: 345–351. MedlineGoogle Scholar
  • 6 Lefkowitz MA, Gobin YP, Akiba Y, et al. Balloon-assisted Guglielmi detachable coiling of wide necked aneurysms. II. Clinical results. Neurosurgery 1999; 45: 531–537. Google Scholar
  • 7 Malek AM, Halbach VV, Phatouros CC, et al. Balloon-assist technique for endovascular coil embolization of geometrically difficult intracranial aneurysms. Neurosurgery 2000; 46: 1397–1406. Crossref, MedlineGoogle Scholar
  • 8 Nelson PK, Levy DI. Balloon-assisted coil embolization of wide-necked aneurysms of the internal carotid artery: medium term angiographic and clinical follow-up in 22 patients. AJNR Am J Neuroradiol 2001; 22: 19–26. MedlineGoogle Scholar
  • 9 Layton KF, Cloft HJ, Gray LA, Lewis DA, Kallmes DF. Balloon-assisted coiling of intracranial aneurysms: evaluation of local thrombus formation and symptomatic thromboembolic complications. AJNR Am J Neuroradiol 2007; 28: 1172–1175. Crossref, MedlineGoogle Scholar
  • 10 Sluzewski M, Von Rooij WJ, Beute GN, Nijssen PC. Balloon-assisted coil embolization of intracranial aneurysms: incidence, complications, and angiography results. J Neurosurg 2006; 105: 396–399. Crossref, MedlineGoogle Scholar
  • 11 Pierot L, Spelle L, Vitry F; ATENA investigators. Immediate clinical outcome of patients harboring unruptured intracranial aneurysms treated by endovascular approach: results of the ATENA study. Stroke 2008; 39: 2497–2504. Crossref, MedlineGoogle Scholar
  • 12 Raymond J, Guilbert F, Weill A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003; 34: 1398–1403. Crossref, MedlineGoogle Scholar

Article History

Published in print: 2009