Endovascular treatment of ruptured tiny (⩽3 mm) intracranial aneurysms in the setting of subarachnoid hemorrhage: A case series of 20 patients and literature review

Anokwute, Miracle C.; Braca, John A.; Bohnstedt, Bradley N.; DeNardo, Andrew J.; Scott, John A.; Cohen-Gadol, Aaron; Sahlein, Daniel

doi:10.1016/j.jocn.2017.01.011

Cited by 19 publications

(23 citation statements)

References 17 publications

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“…It is generally considered difficult and risky to treat a ruptured tiny aneurysm (RTA) via the use of coil embolization 1)3)8)14)18). The main issues are related to the following factors: development of frequently broad-based aneurysms with a shallow dome and complex shape, difficulty in maintaining microcatheter stability, difficulty in achieving complete coil packing, and higher risk of intraprocedural rupture (IPR) and early rebleeding (ERB) 20)22).…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment of ruptured tiny aneurysms

Kim

Choi

Lee

et al. 1970

J Cerebrovasc Endovasc Neurosurg

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Objective : Endovascular coiling of ruptured tiny aneurysms (RTAs) in the brain has been known to be technically challenging owing to the higher rate of adverse events, such as thromboembolism and intraoperative rupture. The aim of this study was to report our ex-periences of endovascular treatment of RTAs (size, ≤3 mm).Methods : From January 2006 to December 2017, 35 RTAs in 35 patients were treated at our institution with an endosaccular coiling. Procedural data and clinical and angiographic results were retrospectively reviewed.Results : The mean size of the RTAs was 2.53 mm (SD: 0.38). The neck remodeling technique was applied to 14 aneurysms, including stent-assisted coiling (n=7) and balloon-assisted coiling (n=7). Procedure-related complications included intraprocedural rupture (n=2), thromboembolic event (n=1), and early rebleeding (n=2), which needed recoiling. Regarding immediate angiographic control, complete occlusion was achieved in 25 aneurysms (71.4%), small neck remnant in 5 (14.3%), and definite remnant in 5 (14.3%). At the end of follow-up, 31 of the 35 patients (88.6%) were able to function independently. Twenty-two of the 35 patients underwent follow-up conventional angiography (mean, 468 days). Stable occlusion was achieved in 20 of the 22 patients (90.9%), minor recanalization in 1 (4.5%), and major recanalization, which required recoiling, in 1 (4.5%).Conclusion : Our experiences demonstrate that endovascular treatment for RTAs is both feasible and effective. However, periprocedural rebleedings were found to occur more often (11.4%) than what is generally suspected.

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Section: Introductionmentioning

confidence: 99%

Endovascular treatment of ruptured tiny aneurysms

Kim

Choi

Lee

et al. 1970

J Cerebrovasc Endovasc Neurosurg

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“…The rates of leaving remnant and recanalization are high in these aneurysms' treatment. Periprocedural complications are also not inconsiderable (3,20,25,32). Oishi et al reported that 481 small (<10 mm) asymptomatic and unruptured aneurysms were treated with or endoluminal reconstruction concept of the parent artery and the exclusion of the aneurysm from the blood flow.…”

Section: A B C D a Bmentioning

confidence: 99%

Flow diverter stents in the treatment of cerebral aneurysms less than 5 mm

Akgül

Onan²,

Bilgin³

et al. 2020

Turkish Neurosurgery

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AIM:To evaluate the safety and efficacy of flow diverter (FD) stents in the treatment of intracranial aneurysms less than 5 mm. MATERIAL and METHODS:We treated 66 aneurysms in 43 patients with aneurysms less than 5 mm. Of the patients, 29 were females and 14 males (mean age: 50.2 years). Headache was the most frequent symptom. In 8 patients the aneurysms were recanalized and these had been treated with coils or stent-assisted coiling. All aneurysms were in the anterior circulation. In the treatment, one of the SILK, Pipeline, Derivo or FRED FD stents was used for each patient. Neurointerventional stent medication (double antiplatelet) was used. All patients were investigated for new ischemic lesions with diffusion-weighted imaging one day later. The first follow-up angiogram was planned 3-6 months later. RESULTS:The treatment was technically successful in all patients. Minor complications occurred in 3 patients (7%). In one patient, thrombus inside the SILK was seen and was relieved with tirofiban. The second patient bled from the right common femoral artery entrance, which was operated on. In the third patient, the complication was technical. All patients were discharged without any neurological deficit. The mean follow-up period was 26 (6-52) months. Of the aneurysms, 64 (97.0%) were completely closed. CONCLUSION:The FD treatment of cerebral, anterior circulation small aneurysms less than 5 mm is effective and safe.

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“…Tiny volume intracranial aneurysms (TVIAs) are commonly defined as the aneurysms with size ≤ 3 mm in diameter. Currently, treatment of ruptured TVIAs is still technically challenging and associated with high risk of intraprocedural perforation due to their tiny volumes and thin fragile walls [ 6 ]. Endovascular treatments using coiling or stent-assisted coiling techniques emerge as important optional therapies for TVIAs because of their less invasive characteristics [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

AngioSuite‐Assisted Volume Calculation and Coil Use Prediction in the Endovascular Treatment of Tiny Volume Intracranial Aneurysms

Cao

et al. 2021

BioMed Research International

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Background and Purpose. Ruptured tiny volume intracranial aneurysms (TVIAs) are associated with high risk of intraprocedural perforation. Aneurysm volume measuring is important for treatment planning and packing density calculation. We aim to assess the ability of the AngioSuite software in calculating TVIAs and guiding the selection of suitable coil. Methods. Thirty-three consecutive patients with 34 TVIAs were prospectively recruited and treated with endovascular techniques. The volume of TVIAs and the required length of coils were calculated by the AngioSuite software before embolization. The treatment efficacy of TVIAs was assessed using the Raymond scale (Rs) and the modified Rankin scale (mRs). Results. Of the 34 aneurysms with an average volume of 7.16 mm3, 13 aneurysms were treated with sole coil embolization, 19 by stent-assisted embolization, and 2 by balloon-assisted embolization. The average coil length was 5.32 cm, and the average packing density was 41.21%. The immediate DSA showed that total occlusion ( Rs = 1 ) was achieved in 15 aneurysms, subtotal ( Rs = 2 ) in 9, and partial ( Rs = 3 ) in 11. Total occlusion was achieved in 30 aneurysms and subtotal in the other 4 aneurysms at 6-month follow-up. Baseline volume and diameter of aneurysms were significantly correlated with the coil length ( r = 0.801 , P < 0.001 ; r = 0.711 , P < 0.001 ). Conclusions. Coil embolization of TVIAs was easy to achieve high packing density. According to the data from AngioSuite, relative few coils can increase the safety in procedure and stenting may reduce risk of aneurysmal recurrence.

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Endovascular treatment of ruptured tiny (⩽3 mm) intracranial aneurysms in the setting of subarachnoid hemorrhage: A case series of 20 patients and literature review

Cited by 19 publications

References 17 publications

Endovascular treatment of ruptured tiny aneurysms

Endovascular treatment of ruptured tiny aneurysms

Flow diverter stents in the treatment of cerebral aneurysms less than 5 mm

AngioSuite‐Assisted Volume Calculation and Coil Use Prediction in the Endovascular Treatment of Tiny Volume Intracranial Aneurysms

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