Endovascular coil embolization of very small intracranial aneurysms

Hwang, Jin Ho; Roh, Hong Gee; Chun, Young Il; Kang, Hyun-Seung; Choi, Jin Woo; Moon, Won‐Jin; Cho, Joon; Moon, Chang Taek; Koh, Young Cho

doi:10.1007/s00234-010-0735-0

Cited by 55 publications

(43 citation statements)

References 20 publications

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“…T o achieve complete coil occlusion of an intracranial aneurysm, a stable microcatheter position is the single most important factor (2,5). A well-designed shape for the microcatheter is crucial in achieving this occlusion.…”

Section: Introductionmentioning

confidence: 99%

Microcatheter Shaping for Intracranial Aneurysm Coiling Using the 3-Dimensional Printing Rapid Prototyping Technology: Preliminary Result in the First 10 Consecutive Cases

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Microcatheter Shaping for Intracranial Aneurysm Coiling Using the 3-Dimensional Printing Rapid Prototyping Technology: Preliminary Result in the First 10 Consecutive Cases

et al. 2015

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“…Several series have reported good results with coiling of very small ruptured aneurysms (≤3 mm) [7,8]. 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.…”

Section: Discussionmentioning

confidence: 97%

“…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%

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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“…Hwang et al [21] reported endovascular treatment of 43 very small aneurysms (23 ruptured, 20 unruptured) in 38 patients. There were 5 incidents of thrombosis (12%) and 1 procedural rupture (2%), but there was no definite adverse effect on clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Very Small and Very Large Ruptured Aneurysms of the Anterior Cerebral Circulation: A Single-Center Experience

Mohammadian¹,

Asgari

Sattarnezhad³

et al. 2013

Cerebrovasc Dis

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Introduction: Endovascular treatment of aneurysms has been introduced as a less invasive method for decreasing the rate of aneurysm rerupture and subsequent subarachnoid hemorrhage. The outcome and complication rate for endovascular treatment of very small (≤3 mm) and very large (15-25 mm) intracranial aneurysms has been controversial. Here we report our experience with endovascular coiling of very small and very large ruptured aneurysms of the anterior cerebral circulation. Methods: Patients were included in the study if the maximum dimension of the intracranial ruptured aneurysm was reported to be ≤3 mm or 15-25 mm and if the aneurysm was within the anterior cerebral circulation. The largest dimension was calculated using CT angiography and was confirmed by digital subtraction angiography. Endovascular coiling was performed using Guglielmi detachable coils. All patients underwent follow-up contrast MR angiography every 6 months. Results: A total of 40 cases (18 females and 22 males) were included in this single-center study. Twenty-one very small and 19 very large ruptured aneurysms were analyzed. Preprocedural Hunt and Hess grades were determined. Endovascular coiling was performed successfully in most cases (97.5%), with unsuccessful coiling in 1 patient with a very small ruptured aneurysm. In the very small aneurysm group, the most common location was the anterior communicating artery and, in the large aneurysm group, the most common location was the middle cerebral artery (MCA) bifurcation. The mean follow-up time was 15.08 months (range: 6-30 months). The 6th month modified Rankin scale (mRS) values for very small aneurysm cases were 0 (no symptoms at all) in 16 cases (76.2%) and 1 (no significant disability despite symptoms) in 5 cases (23.80%). For the very large aneurysm cases, the mRS values were 1 in 2 cases (10.5%), 2 in 7 cases (36.8%), 3 in 6 cases (31.6%), 4 in 3 cases (15.8%) and 6 in 1 case (died due to vasospasm 72 h later; 5.2%). The immediate complications that were observed were MCA branch occlusion in 1 very small aneurysm patient and early vasospasms in 3 very large aneurysm patients. The late complication that was observed was recanalization in 1 very small aneurysm case (1/21, 4.76%) and in 5 very large aneurysm cases (5/18, 27.77%). Conclusion: Endovascular treatment of very small aneurysms is an effective method of treatment with acceptable immediate and long-term outcomes. Immediate and long-term complications were more prevalent in very large ruptured aneurysms.

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Endovascular coil embolization of very small intracranial aneurysms

Abstract: Coil embolization of very small aneurysms may be technically feasible with favorable clinical/angiographic outcomes and relatively low recanalization rate during 6 months or more follow-up period.

Cited by 55 publications

References 20 publications

Microcatheter Shaping for Intracranial Aneurysm Coiling Using the 3-Dimensional Printing Rapid Prototyping Technology: Preliminary Result in the First 10 Consecutive Cases

Microcatheter Shaping for Intracranial Aneurysm Coiling Using the 3-Dimensional Printing Rapid Prototyping Technology: Preliminary Result in the First 10 Consecutive Cases

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

Endovascular Treatment of Very Small and Very Large Ruptured Aneurysms of the Anterior Cerebral Circulation: A Single-Center Experience

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