Waffle-cone technique with Solitaire™ AB remodeling device: endovascular treatment of highly selected complex cerebral aneurysms

Neuroradiology. 2011 Dec;53(12):961-72. doi: 10.1007/s00234-010-0766-6. Epub 2010 Sep 7.


Introduction: To evaluate patients with complex aneurysms who underwent waffle-cone stent-assisted coil embolization.

Methods: From February 2008 to February 2010, consecutive data were collected from 80 patients with aneurysms treated with the Solitaire™ AB Remodeling Device followed by a standard coiling procedure using bare or/and bioactive coils. Six of these patients were treated using the "waffle-cone-technique" placing the distal end of a stent directly into the base of a bifurcation aneurysm and coiling through the expanded and cone-shaped distal end of the stent allowing for preservation of parent artery patency. The aneurysms were located at the P3 segment of the posterior cerebral artery (n = 1), the middle cerebral artery bifurcation (n = 1), the basilar tip (n = 2), and the AComAnt (n = 2). Four patients underwent follow-up (2-7 months, mean 4.5 months).

Results: Waffle-cone positioning of the Solitaire™ AB Remodeling Device was obtained in all cases without technical problems. No permanent procedural morbidity was observed. In all patients, a Raymond class 2 occlusion was obtained and five patients left the hospital with a good clinical status (mRS0 n = 3, mRS1 n = 1) or no new neurologic deficits (mRS4 n = 1). One patient with SAH III died due to severe vasospasms. Due to major recanalization during follow-up, retreatment was necessary or is planned in four cases; one asymptomatic intimal hyperplasia was observed 8 weeks after initial treatment.

Conclusion: The waffle-cone technique may enhance the possibilities of the endovascular treatment of these complex aneurysms. Due to the high rate of recanalization requiring endovascular retreatment, stringent angiographic and clinical follow-up is warranted.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Endovascular Procedures / instrumentation*
  • Endovascular Procedures / methods*
  • Female
  • Humans
  • Intracranial Aneurysm / diagnostic imaging*
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Prosthesis Design
  • Radiography, Interventional / methods*
  • Treatment Outcome