Objectives: Endovascular treatment of intracranial aneurysms (IAs) has evolved in recent years and is currently the preferred treatment worldwide. We analyzed the trends in the number of patients, number of aneurysms, aneurysm characteristics, and techniques used in a pure endovascular cohort of patients treated in a reference center. Materials and Methods: Between 2010 and 2020, a retrospective data collection of patients who underwent endovascular intervention of IAs was performed. We used the Mann-Kendal test to evaluate the trends. In addition, the moving-average technique was used to assess smoother curves. Results: Eight hundred and forty-five aneurysms were treated in 765 patients, the mean age was 53.9 ± 14.6 years and 81% were women. The number of patients (P = 0.016) and aneurysms (P = 0.003) increased significantly. Unruptured (P = 0.029) and posterior communicating artery aneurysms increased their frequency of treatment (P = 0.042). Balloon remodeling (P = 0.01) and the use of flow diverters showed a positive trend (P = 0.016). Conclusion: There have been an increased number of patients and aneurysms treated endovascularly at our institution, including unruptured and posterior communicating aneurysms. Advanced endovascular techniques also increased. Comparative studies including surgical cases must be done in our region to determine the best approach.

Introduction : Large volume coils in the treatment of intracranial aneurysms have demonstrated better packing density, shorter operative times, less number of coils per aneurysm and better cost‐effectiveness. However, most of the studies evaluated these coils in small or medium sized aneurysms. Therefore, our study aimed to determine our experience using large volume coils in the treatment of large intracranial aneurysms and determine its safety and efficacy. Methods : We retrospectively reviewed consecutive cases of intracranial aneurysms treated with Penumbra Coils 400 (PC400) at our institution between May 2016 and September 2019. Aneurysms > 12 mm in maximal diameter were selected according to the ISUIA trial. Clinical and radiological variables were collected. The modified Rankin Scale (mRS) was used to determine the clinical outcome and was dichotomized (good clinical outcome: mRS £2; poor clinical outcome: mRS >2). The Raymond Roy occlusion classification (RROC) was used to determine obliterations rates. An adequate obliteration was defined as RROC 1 or 2. Categorical variables were expressed as percentages and continuous variables as mean ± standard deviation. Stata v14 software was used for the analysis. Results : Eighteen patients harboring 18 intracranial aneurysms were treated. The mean age was 55 ± 12 years and 14 patients (78%) were women. A good preoperative clinical condition was found in 13 patients (72%). Ten aneurysms were unruptured (56%) and eight were dysplastic (44%). Paraclinoid aneurysms were the most frequently treated (61%). The mean number of coils were 6.2/aneurysm. The mean maximal diameter and neck were 18.9 ± 4.3 mm, and 5.7 ± 2.6 mm, respectively. The mean aspect ratio (AR) was 4 ± 1.9. Coiling was used in 10 cases (56%) followed by stent‐assisted coiling in 7 cases (39%) and balloon‐assisted coiling in 1 case. An immediate adequate obliteration rate was found in 8 cases (44%). Intraoperative complications occurred in two patients in which a coil loop migrated to the parent artery and a stent was placed without clinical consequences. In twelve patients (67%), angiographic follow‐up was performed. The mean follow‐up duration was 9.7 months. Nine patients (75%) showed a complete obliteration (RROC 1), whereas in three patients a residual aneurysm was still present. A good postoperative clinical outcome at discharge was found in 14 patients (78%). Procedure‐related morbidity and mortality were not reported. Conclusions : Embolization with large volume coils is a safe and effective alternative to conventional coils, with high obliteration rates at mid‐term follow‐up. Longer duration of angiographic follow‐up are needed in order to confirm the results presented here.

Introduction : Endovascular treatment of intracranial aneurysms has increased compared to microsurgery since the creation of the Guglielmi Detachable Coils (GDC), and is the treatment of choice in several centers worldwide. Our study aimed to analyze the trends over time of number of patients, number of aneurysms, rupture status, location, size and endovascular technique employed in a retrospective cohort of consecutive intracranial aneurysms treated during a 10‐year period. Methods : Data extracted from clinical records, surgical reports, angiographies and CT scans of 765 consecutive patients who underwent endovascular treatment of 845 intracranial aneurysms at our institution between January 2010 and December 2020 was carried out. The Mann‐Kendal test was used to assess time trends. The moving average technique was also employed, using one lagged observation, the current observation and one forward observation in order to create smoother curves. The statistical software Stata v14.0 (StataCorp, College Station, TX, USA) was used. Results : We evaluated 765 patients who underwent 845 endovascular treatments of intracranial aneurysms. Women represented 81% of the cohort. Mean age was 53.9 ± 14.6 years. We identified a significant increase in the number of patients (p = 0.016; p for moving average = 0.005) and in the number of aneurysms over time (p = 0.003; p for moving average = 0.003). For ruptured aneurysms, we did not find changes in the trends over time (p = 0.117; p for moving average = 0.1), whereas in the case of unruptured aneurysms, we identified a significant increase in their treatment (p = 0.029; p for moving average = 0.001). Posterior communicating (p = 0.042: p for moving average = 0.002), paraclinoid (p = 0.06; p for moving average = 0.019) and posterior fossa aneurysms (p = 0.813; p for moving average = 0.028) increased their frequency of treatment over time. Anterior communicating (p = 0.235; p for moving average = 0.21), middle cerebral artery (p = 0.431; p for moving average = 0.347) and internal carotid artery aneurysms (p = 1; p for moving average = 0.754) did not show differences over time. We did not identify changes over time in large (p = 0.31; p for moving average = 0.213), as well as width (p = 0.35; p for moving average = 0.876) and neck diameter (p = 1; p for moving average = 0.815). Balloon‐assisted coiling (p = 0.01; p for moving average = 0.003), flow diverters (p = 0.016; p for moving average < 0.001) and stent‐assisted coiling (p = 0.531; p for moving average = 0.014) showed a positive trend over time. Simple coiling (p = 0.75; p for moving average = 0.184) did not show significant variations over time. Conclusions : We identified a positive trend in the endovascular treatment of unruptured aneurysms, as well as posterior communicating artery, paraclinoid and posterior fossa aneurysms. Assisted‐coiling techniques and flow diverters also showed a positive trend over time. These results are in accordance with the increasing trends in endovascular treatment of intracranial aneurysms worldwide.

Introduction : C‐Guard carotid stent is a self‐expandable open cell stent covered with a double‐layer mesh which was developed for the treatment of internal carotid artery disease. Lower procedural and complications rates, as well as lower post‐operative infarctions are some advantages of this device. Nevertheless, the use of C‐Guard in the treatment of cervical internal carotid artery (ICA) aneurysms is scarce. Therefore, we present two cases in which the C‐Guard stent achieved complete angiographic occlusion at follow‐up. Methods : We identified two cases in which the C‐Guard carotid stent was used to treat symptomatic cervical ICA aneurysms. Angiographic follow‐up was performed. Results : Case 1: 47‐yo female presented left‐sided motor deficit. CT showed ischemic areas in the right hemisphere and CTA demonstrated an unruptured aneurysm in the C1 segment of the right ICA. The patient started dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. A 6mm x 40 mm C‐Guard carotid stent was deployed without complications. One‐year follow‐up CTA showed complete obliteration of the aneurysm with reconstruction of the ICA. Case 2: 38‐yo male presented decreased left visual acuity. CTA and DSA showed an unruptured aneurysm in the C1 segment of the ICA. The patient started DAPT with aspirin and clopidogrel. A 7mm x 30 mm C‐Guard carotid stent was deployed without complications. Three‐month follow‐up DSA showed complete obliteration of the aneurysm with adequate filling of distal vessels. Conclusions : C‐Guard stent is a potential alternative to conventional carotid stents in the treatment of cervical ICA aneurysms with high obliteration rates at follow‐up.