Contemporary endovascular and open aneurysm treatment in the era of flow diversion

Abstract

Clinical outcomes have improved considerably over the last decade for patients with ruptured and unruptured aneurysms. Modern endovascular techniques, such as flow diversion, are associated with high aneurysm occlusion rates and have become a popular treatment modality for many types of aneurysms. However, the safety and effectiveness of flow diversion has not yet been established in trials comparing it with traditional aneurysm treatments. Moreover, there are some types of aneurysms that may not be appropriate for endovascular coiling, such as wide-necked aneurysms located at branch points of major vessels, large saccular aneurysms with multiple efferent arteries, dolichoectatic aneurysms, large aneurysms with mass effect, when there are technical complications with endovascular treatment, when patients cannot tolerate or have contraindications to antiplatelet therapy or in the setting of a subarachnoid haemorrhage. For these cases, open cerebrovascular surgery remains important. This review provides a discussion on the current trends and evidence for both flow diversion and open cerebrovascular surgery for complex aneurysms that may not be suitable for coiling. We emphasise a continued important role for surgical treatment in certain situations.

Endovascular embolization of visceral artery aneurysm: A retrospective study

“…[9]. Moreover, endovascular treatment has been proven to be a safe and effective treatment with fewer complications and shorter hospitalization periods than open surgery [10,11].…”

“…Most pseudoaneurysms have symptoms such as abdominal pain and bleeding, and in view of their risk, more attention should be paid to symptomatic patients and the nature of the aneurysm should be determined as soon as possible to determine the next stage of treatment.[9]. Moreover, endovascular treatment has been proven to be a safe and effective treatment with fewer complications and shorter hospitalization periods than open surgery [10,11].Few studies have investigated the embolization treatment of symptomatic VAA (SVAA) and asymptomatic VAA (ASVAA). Therefore, the purpose of our current study was to compare the perioperative and follow-up outcomes of SVAA and ASVAA after coil embolization.…”

Microcatheter-guided compartment packing of acutely ruptured complex intracerebral aneurysms (ARCIAs): Preliminary experience and technical note

“…Up to 25% of surgical neurointerventions fail in attempted endovascular treatment of intracranial aneurysms ( 7 ). Some ARCIAs require revascularization techniques, including extracranial-to-intracranial carotid artery bypass with aneurysm clipping or distal or proximal arterial occlusion, intracranial-to-intracranial bypass, and excision of the diseased segment with direct vessel revascularization ( in situ bypass) ( 1 , 43 ). Future studies are needed to explore whether the MCP technique can guide the choice of surgical modalities for the revascularization of such CIAs.…”

Endovascular embolization of visceral artery aneurysm: a retrospective study

“…In recent years, with the rapid development of endovascular therapy techniques, coil embolization has become the most commonly used procedure for the treatment of VAA 9 . Moreover, endovascular treatment has been proven to be a safe and effective treatment with fewer complications and shorter hospitalization periods than open surgery 10 , 11 .…”