Embolization of very small (≤3 mm) unruptured intracranial aneurysms: A large single-center experience on treatment of unruptured versus ruptured cases

Pop, Raoul; Aloraini, Ziad; Mihoc, Dan; Manisor, Monica; Richter, Johann Sebastian; Simu, Mihaela; Chibbaro, Salvatore; Proust, F.; Wolff, Valérie; Beaujeux, R.

doi:10.1016/j.wneu.2019.05.070

Cited by 15 publications

(16 citation statements)

References 28 publications

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“…A recent meta-analysis by Yamaki et al ( 11 ) reported the IPR rate of endovascular treatment for VSIAs was 7%, which was lower than they had previously reported (8.3%) ( 7 ). In the study by Pop et al ( 12 ), 97 patients with VSIAs were treated by coil embolization and only one patient experienced IPR (1%). In our cohort, perioperative aneurysm re-rupture occurred in only two patients (IPR rate = 1.3%), which was consistent with previous studies.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Ruptured Very Small Intracranial Aneurysms: Complications, Recurrence Rate, and Clinical Outcomes

et al. 2022

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Objective: The aim of this study was to evaluate the safety and efficacy of endovascular treatment for ruptured very small (≤3 mm) intracranial aneurysms (VSIAs).Methods: The clinical data and imaging results for 152 patients with VSIAs treated with coil embolization from August 2014 to June 2020 were retrospectively reviewed. The influential factors related to the preoperative complications, aneurysm recurrence, and clinical outcomes for these patients were analyzed.Results: Among 152 patients with ruptured VSIAs, 90 were treated with coil embolization alone, while 62 were treated with stent-assisted coil embolization. Eighteen patients experienced intra and/or postoperative complications (overall incidence = 11.8%). One person died of intraoperative aneurysm re-rupture and postoperative rebleeding (mortality rate = 0.65%). Twenty patients had various degrees of neurological dysfunction (morbidity rate = 13.1%). Statistical analysis showed that there was no independent risk factor associated with perioperative complications. The rate of complete aneurysm occlusion at discharge and follow-up was 76.3 and 86.2%, respectively. A total of 105 patients underwent digital subtraction angiography during follow-up, and 18 of them experienced postoperative recurrence (recurrence rate = 17.1%). Seven patients were retreated (retreatment rate = 6.7%). The use of stents was the only factor that affected the postoperative recurrence of aneurysm. The incidence of favorable clinical outcomes (Glasgow Outcome Scale score ≥ 4) at discharge and follow-up was 86.2 and 97.1%, respectively. Univariate analysis showed that the preoperative Hunt-Hess grade, CT Fisher grade, and perioperative complications were risk factors for poor clinical outcomes. Multiple logistic regression analysis showed that perioperative complication was the most significant risk factor for the clinical prognosis of patients with ruptured VSIAs.Conclusion: Endovascular treatment is a safe and efficient approach for ruptured VSIAs. Stent-assisted coiling reduced the recurrence rate of aneurysm without increasing the incidence of perioperative complications. The Hunt-Hess grade, CT Fisher grade, and perioperative complications were independent factors associated with the clinical outcomes of patients with ruptured VSIAs, and perioperative complication was the most significant risk factor for poor prognosis in patients.

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Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Ruptured Very Small Intracranial Aneurysms: Complications, Recurrence Rate, and Clinical Outcomes

et al. 2022

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“…Therefore, whether unruptured aneurysms require active intervention has aroused great controversy (15). However, according to a recent study, the rate of rupture during interventional therapy for tiny aneurysms was significantly lower, at 1% (16). With improved embolization materials, such as smaller and softer coils, steerable microcatheters, and increased embolization skill, there were no intraoperative aneurysm ruptures in any of our 42 patients.…”

Section: Treatment Of Tiny Aneurysmsmentioning

confidence: 73%

Endovascular Treatment of Tiny Aneurysms With Low-Profile Visualized Intraluminal Support Devices Using a “Compressed” Stent Technique

Zhou

Peng

et al. 2020

Front. Neurol.

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Objective: To investigate the safety and efficacy of low-profile visualized intraluminal support (LVIS) stent-assisted coiling of intracranial tiny aneurysms using a “compressed” stent technique.Methods: We retrospectively analyzed patients with tiny aneurysms treated in our hospital with LVIS devices using a compressed stent technique. We analyzed patients' imaging outcomes, clinical outcomes, and complications.Results: Forty-two tiny aneurysms in 42 patients were included in this study cohort; 8 patients presented with subarachnoid hemorrhage at admission. The immediate postoperative complete embolization rate was 76.2% (32/42). After an average of 8.5 months of imaging follow-up, the complete embolization rate was 90.5% (38/42), and no aneurysm recanalization occurred. After an average of 24.4 months of clinical follow-up, 95.2% (40/42) of the patients achieved favorable clinical outcomes (modified Rankin scale = 0/1). Operation-related complications occurred in two patients (4.8%); one intraoperative acute thrombosis, and one significant unilateral decreased vision during the postoperative follow-up.Conclusion: LVIS stent-assisted coiling of intracranial tiny aneurysms using a compressed stent technique is safe and effective. Combined stent compression technology is beneficial to maximize the complete embolization of aneurysms and reduce aneurysm recanalization. This study expands the clinical applicability of LVIS stents.

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“…However, these results can not be applied to very small IAs patients simply, because there are some differences in natural history, aneurysm characteristics and so on. Although no randomized clinical trial (RCT) comparing these two treatment methods, some retrospective and prospective studies [24,25,26,27,28] reported the outcomes of clipping or coiling in very small UIAs. Moroi et al [29] reported the total morbidity and mortality of 368 cases of UIAs treated with clipping were 0.3% and 2.2% respectively, while the morbidity and mortality of small UIAs in different location of aneurysm were lower than those of large UIAs.…”

Section: Discussionmentioning

confidence: 99%

“…Raoul et al [24] reported the 67 very small UIAs treated by coiling, and the good outcome rate was 97.0%, and the intraprocedural perforation and neurological morbidity rate were 1.7% and 2.8%, respectively. Their study showed that the rate of procedural perforation was lower than previously reported results with technical evolution of endovascular devices.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have reported endovascular coiling or microsurgical clipping of small IAs [15,16] , but studies on the treatment of very small IAs are still rare. Although there is a high risk of treatment for very small RIAs [17,18] , however the outcome of preventive treatment for very small UIAs are satisfactory [19,20] . To better describe the treatment outcomes of very small RIAs and UIAs, we report our center's experience and the results of a meta-analysis of the literature on coiling and clipping of very small IAs.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes After Endovascular and Microsurgical Treatment of Very Small Intracranial Aneurysms: Report of a Consecutive Series and Meta-analysis

Zheng

Sun

Zhang

2020

Preprint

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Objective: We conducted a systematic review and meta-analysis of studies evaluating endovascular coiling or microsurgical clipping of very small intracranial aneurysms (IAs), including 126 patients treated in our center.Data Sources: The electronic database of PubMed, Embase, and Web of Science were systematically searched for studies on endovascular or microsurgical treatment of very small IAs. The search was performed by using the keywords and medical subject heading (MeSH) terms: “intracranial aneurysm,” “cerebral aneurysm,” “outcome,” “endovascular,” “coil,” “embolization,” “coiling,” “surgical,” “neurosurgical,” “microsurgical,” “clip,” “clipping,” “small,” and “tiny” in both AND and OR combinations.Study Selection: Only studies of very small (Size ≤ 3 mm) ruptured or unruptured IAs patients undergoing endovascular coiling or microsurgical clipping were included.Data Extraction: Data collection and quality assessment were conducted independently by two authors.Data Synthesis: A total of 6 studies provided data on 362 very small UIAs and 9 studies provided data on 703 very small RIAs. Of 362 patients with very small UIAs, 6 (1.7%) cases had operation-related neurological deficits, and no patient died. Of 731 patients with very small RIAs, the morbidity and mortality were 13.0% and 4.7%, respectively. Morbidity due procedure-related complications was 8.3% (95% CI, 3.5% to 13.1%) in coiled very small RIAs patients compared with 20.6% (95% CI, 10.5% to 30.8%) in clipped very small RIAs patients. Mortality due to procedure-related complications was 5.3% (95% CI, 2.9% to 7.7%) in coiled very small RIAs patients compared with 4.7% (95% CI, 2.0% to 7.3%) in clipped very small RIAs patients. No significant differences were found in the incidence of poor outcomes observed between microsurgical and endovascular treatment for very small RIA patients (RR, 1.38; 95% CI, 0.99 - 1.93; P = 0.06).Conclusions Very small UIAs can be treated effectively and safely with good long-term outcomes. However, very small RIAs patients are at high risk of poor outcome and the incidence of neurological complication should not be ignored.

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Embolization of very small (≤3 mm) unruptured intracranial aneurysms: A large single-center experience on treatment of unruptured versus ruptured cases

Cited by 15 publications

References 28 publications

Endovascular Treatment of Ruptured Very Small Intracranial Aneurysms: Complications, Recurrence Rate, and Clinical Outcomes

Endovascular Treatment of Ruptured Very Small Intracranial Aneurysms: Complications, Recurrence Rate, and Clinical Outcomes

Endovascular Treatment of Tiny Aneurysms With Low-Profile Visualized Intraluminal Support Devices Using a “Compressed” Stent Technique

Clinical Outcomes After Endovascular and Microsurgical Treatment of Very Small Intracranial Aneurysms: Report of a Consecutive Series and Meta-analysis

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