Objective and importance: Although surgical treatment of saccular aneurysms continues to be the gold standard of care, certain situations arise for which surgery may not be the best option. In these cases, electrically detachable coils have proven to provide superior outcomes in aneurysms left to medical management alone. An anterior communicating artery aneurysm with an anatomic neck wider than the fundus of the aneurysm failed to accommodate an initial attempt at Guglielmi detachable coil placement and was treated with an adjunctive balloon technique that allowed safe and effective aneurysm occlusion.
Clinical presentation: The patient presented with an asymptomatic anterior communicating artery aneurysm that was detected incidentally on angiography after rupture of a giant middle cerebral artery aneurysm.
Intervention: Transarterial embolization of the patient's aneurysm was attempted with Guglielmi detachable coils. Although this procedure initially failed, it was then successfully performed when combined with a balloon angioplasty technique.
Conclusion: The Guglielmi detachable coils were able to be placed when a nondetachable balloon was used to occlude the neck of the aneurysm and allow for the coils to be deposited into the aneurysm while protecting the parent vessel.