Learning Curve

Aneurysm coiling is a complex procedure that can be improved with practice. Malish et al. (57) showed a steep learning curve by comparing the complication rate of coiling of their first 100 patients with ruptured aneurysms with

Balloon Occlusion Test

Fig. 6. Sacrifice of the parent vessel to obliterate a large right internal carotid artery (ICA) aneurysm with an indistinct neck. After a previous attempt at microsurgical trapping was unsuccessful, it was decided to perform coil takedown of the parent vessel. The patient did well during balloon occlusion testing of the right ICA prior to permanent occlusion with coils. Followup angiography (bottom panel) confirmed no flow into the aneurysm and parent vessel after 2 yr.

Fig. 6. Sacrifice of the parent vessel to obliterate a large right internal carotid artery (ICA) aneurysm with an indistinct neck. After a previous attempt at microsurgical trapping was unsuccessful, it was decided to perform coil takedown of the parent vessel. The patient did well during balloon occlusion testing of the right ICA prior to permanent occlusion with coils. Followup angiography (bottom panel) confirmed no flow into the aneurysm and parent vessel after 2 yr.

the next 100 patients. The procedure-related complications rate dropped from 14% in the first 100 patients to 7% in the next 100 patients. A dramatic decrease of the complication risk with increasing experience was also shown for coiling of unruptured aneurysms (93).

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