Document Detail

Endovascular treatment of very small intracranial aneurysms.
MedLine Citation:
PMID:  19715422     Owner:  NLM     Status:  MEDLINE    
OBJECT: Endovascular treatment of very small aneurysms poses a significant technical challenge for endovascular therapists. The authors review their experience with a series of patients who had intracranial aneurysms smaller than 3 mm in diameter. METHODS: Between 1995 and 2006, 97 very small aneurysms (defined for purposes of this study as < 3 mm in diameter) were diagnosed in 94 patients who were subsequently referred for endovascular treatment. All patients presented after subarachnoid hemorrhage, which was attributed to the very small aneurysms in 85 patients. The authors reviewed the endovascular treatment, the clinical and angiographic results of the embolization, and the complications. RESULTS: Five (5.2%) of the 97 endovascular procedures failed, and these patients underwent craniotomy and clip ligation. Of the 92 aneurysms successfully treated by coil embolization, 64 (69.6%) were completely occluded and 28 (30.4%) showed minor residual filling or neck remnants on the immediate postembolization angiogram. Complications occurred in 7 (7.2%) of 97 procedures during the treatment (3 thromboembolic events [3.1%] and 4 intraprocedural ruptures [4.1%]). Seventy-six patients were followed up angiographically; 4 (5.3%) of these 76 showed angiographic evidence of recanalization that required retreatment. The clinical outcomes for the 76 patients were also graded using the Glasgow Outcome Scale. In 61 (80.3%) cases the outcomes were graded 4 or 5, whereas in 15 (19.7%) they were graded 3. Seven patients (7.4%) died (GOS Grade 1), 2 due to procedure-related complications (intraoperative rupture) and 5 due to complications related to the presenting subarachnoid hemorrhage. CONCLUSIONS: Endosaccular coil embolization of very small aneurysms is associated with relatively high rates of intraprocedural rupture, especially intraoperative rupture. With the advent of more sophisticated endovascular materials (microcatheters and microguidewires, soft and ultrasoft coils, and stents) endovascular procedures have become feasible and can lead to a good angiographic outcome.
Ioannis Ioannidis; Shivendra Lalloo; Rufus Corkill; Wilhelm Kuker; James V Byrne
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  112     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-02     Completed Date:  2010-04-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  551-6     Citation Subset:  AIM; IM    
Neuroradiology Department, West Wing, John Radcliffe Hospital, Oxford, United Kingdom.
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MeSH Terms
Aged, 80 and over
Balloon Occlusion / methods
Cerebral Angiography
Cohort Studies
Embolization, Therapeutic / adverse effects,  instrumentation*,  methods*
Follow-Up Studies
Intracranial Aneurysm / pathology,  surgery,  therapy
Middle Aged
Subarachnoid Hemorrhage / pathology,  surgery,  therapy*
Treatment Outcome
Comment In:
J Neurosurg. 2010 Mar;112(3):549; discussion 550   [PMID:  19715425 ]

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