Coil Embolization of Very Small (2 mm or Smaller) Berry Aneurysms: Feasibility and Technical Issues

Gupta, Vipul; Chugh, Manish; Jha, Ajaya Nand; Walia, Bipin; Vaishya, Sandeep

doi:10.3174/ajnr.a1374

Cited by 63 publications

(39 citation statements)

References 15 publications

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“…[2][3][4][5][6][7][8] This group of aneurysms was not included in the International Subarachnoid Aneurysm Trial, 9,10 because coiling of such tiny aneurysms was considered to be technically challenging due to the higher procedural perforation rate and the relatively wide aneurysm neck. 3,7 Open surgery is thus usually advocated. However, surgical treatment of ruptured tiny intracranial aneurysms (RTIA) is challenging because they are often thin-walled and may be too small to clip without narrowing or tearing the parent vessel.…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment of ruptured tiny intracranial aneurysms

Hong¹,

Yang²,

Zhao

et al. 2011

Journal of Clinical Neuroscience

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Section: Introductionmentioning

confidence: 99%

Endovascular treatment of ruptured tiny intracranial aneurysms

Hong¹,

Yang²,

Zhao

et al. 2011

Journal of Clinical Neuroscience

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“…10) In our experience there were no problems regarding catheter shaping or coil size selection based on measurements using these technologies. When selecting a high-power field on fluoroscopy or angiography intraoperatively, there is the problem of increased exposure dose.…”

Section: Discussionmentioning

confidence: 99%

Coil Embolization of Cerebral Tiny Aneurysms

Kuroiwa

Shimizu

Yamashita

et al. 2016

JNET

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Purpose:We retrospectively examined the results of coil embolization for 28 cerebral tiny aneurysms (<3 mm), 73 small cerebral aneurysms (3-4 mm) and associated complications. Subjects and Methods:From a total of 418 patients who underwent coil embolization of cerebral aneurysms (n = 433) between January 2008 and August 2015, we analyzed 28 cerebral tiny aneurysms (6.5%) and 73 small aneurysms (16.9%). The type of procedure, results of embolization, and complications were compared.Results: For 23 (82.1%) of the 28 tiny aneurysms and 52 (71.2%) of the 73 small aneurysms, embolization was performed using a simple technique. Embolization resulted in complete obliteration (CO) and neck remnant (NR) in 26 (92.9%) of the 28 tiny aneurysms, and CO + NR was achieved in 62 (84.9%) of the 73 small aneurysms. Treatment was discontinued for one tiny aneurysm and one small aneurysm. Intraoperative rupture occurred in one tiny aneurysm and three small aneurysms. Thromboembolism was observed in one tiny aneurysm and one small aneurysm. Morbidity was encountered in one tiny aneurysm (thromboembolism), and mortality was associated with another tiny aneurysm (intraoperative rupture). Conclusion:The results of coil embolization for tiny aneurysms were similar to those of small aneurysms. Coil embolization-related complications and prognosis were also considered to be similar.Keywords▶ tiny cerebral aneurysm, small cerebral aneurysm, coil embolization IntroductionAfter coil embolization of cerebral aneurysms became covered by national health insurance in 1997, there has been increasingly rate procedures performed in Japan. With the introduction of various devices, such as coils, balloons, and stents, and advances in cerebral angiographs, coil embolization has been accepted as a standard treatment. However, tiny cerebral aneurysms measuring ≤3 mm (tiny aneurysm (AN)) are still difficult to treat because of a high incidence of intraoperative rupture, thromboembolism, and postoperative hemorrhage related to the extremely small size. [1][2][3][4][5][6][7] In this study, we retrospectively investigated comparative outcomes and complications for endovascular coil embolization of patients with tiny ANs measuring ≤3 mm and small aneurysms (small ANs) measuring 3 mm to 4 mm among our series of cerebral aneurysms. Subjects and MethodsOf 482 patients who underwent coil embolization of cerebral aneurysms in our hospital and affiliated hospitals between January 2008 and August 2015, we retrospectively analyzed the results of 418 patients (433 aneurysms). Recurrent aneurysms and cases where measurement data were unclear were excluded. Of the 433 aneurysms, 28 were classified as tiny ANs (6.5%), and 73 as small ANs (16.9%). The mean ages of tiny and small AN patients were 63.6 ± 15.7 years and 65.1 ± 13.0 years, respectively. Women accounted for 71.4% (n = 20) of the tiny AN patients and 75.3% (n = 55) of the small AN patients.Location of tiny ANs was as follows: 5 ICA aneurysms (18.5%), 14 (51.9%) ACA + Acom, 4 BA, 3 VA, and 1 MCA. The distri...

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“…In another patient, a residual wide-neck carotid terminus aneurysm was clipped after 9 months from the ictus to offer definitive treatment following stabilization by coiling. Despite the good aneurysm occlusion rates reported [8,10], we continue to advocate close follow-up for recanalization in this small and select patient population.…”

Section: Discussionmentioning

confidence: 99%

“…In other series, even smaller ruptured aneurysms (≤2 mm) have been treated by coiling, including Gil et al's series of 4 patients [9] and Gupta et al's [10] series of 7 patients, both with good outcomes. Recently, Jindal et al [11 ]shared their experience using 1-1.5-mm Target Nano coils (Stryker Neurovascular, Fremont, Calif., USA) in 14 aneurysms ranging from 1.5-3.5 mm in size; there were no immediate procedural complications reported.…”

Section: Discussionmentioning

confidence: 99%

“…The vessel wall of the aneurysm may be too small or thin-walled to accept a clip without narrowing or tearing the parent vessel [9,10], and the lack of clip purchase due to aneurysm size and geometry may likely constitute to increased failure rates. Furthermore, elderly, high-grade subarachnoid hemorrhage patients may not be ideal candidates for surgery.…”

Section: Discussionmentioning

confidence: 99%

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Expanding Endovascular Therapy of Very Small Ruptured Aneurysms with the 1.5-mm Coil

et al. 2015

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Background: Very small ruptured aneurysms (≤3 mm) demonstrate a significant risk for procedural rupture with endovascular therapy. Since 2007, 1.5-mm-diameter coils have been available (Micrus, Microvention, and ev3), allowing neurointerventionalists the opportunity to offer patients with very small aneurysms endovascular treatment. In this study, we review the clinical and angiographic outcome of patients with very small ruptured aneurysms treated with the 1.5-mm coil. Methods: This is a retrospective cohort study in which we examined consecutive ruptured very small aneurysms treated with coil embolization at a single institution. The longest linear aneurysm was recorded, even if the first coil was sized to a smaller transverse diameter. Very small aneurysms were defined as ≤3 mm. Descriptive results are presented. Results: From July 2007 to March 2015, 81 aneurysms were treated acutely with coils in 78 patients presenting with subarachnoid hemorrhage. There were 5 patients with 3-mm aneurysms, of which the transverse diameter was ≤2 mm in 3 patients. In all 5 patients, a balloon was placed for hemostatic prophylaxis in case of rupture, and a single 1.5-mm coil was inserted for aneurysm treatment without complication. Complete aneurysm occlusion was achieved in 1 patient, residual neck in 2, and residual aneurysm in 2 patients. Aneurysm recanalization was present in 2 patients with an anterior communicating artery aneurysm; a recoiling attempt was unsuccessful in 1 of these 2 patients due to inadvertent displacement and distal coil embolization, but subsequent surgical clipping was successful. Another patient was retreated by surgical clipping for a residual wide-neck carotid terminus aneurysm. One patient died of ventriculitis 3 weeks after presentation; all 4 other patients had an excellent outcome with no rebleed at follow-up (mean 21 months, range 1-62). Conclusion: The advent of the 1.5-mm coil may be used in the endovascular treatment of patients with very small ruptured aneurysms, providing a temporary protection to the site of rupture in the acute phase. If necessary, bridging with elective clipping may provide definitive aneurysm treatment.

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Coil Embolization of Very Small (2 mm or Smaller) Berry Aneurysms: Feasibility and Technical Issues

Cited by 63 publications

References 15 publications

Endovascular treatment of ruptured tiny intracranial aneurysms

Endovascular treatment of ruptured tiny intracranial aneurysms

Coil Embolization of Cerebral Tiny Aneurysms

Expanding Endovascular Therapy of Very Small Ruptured Aneurysms with the 1.5-mm Coil

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