Endovascular Treatment of Very Small Intracranial Aneurysms

Abstract

<jats:p> The endovascular treatment of intracranial aneurysms 3 mm or less is considered controversial. The purpose of this study is to report angiographic and clinical results following coiling of such aneurysms and compare them to those of larger aneurysms (&gt; 3 mm). </jats:p><jats:p> Between November 1999 and November 2009 endovascular treatment was attempted in 956 consecutive intracranial aneurysms. Of 956 aneurysms, 111 aneurysms were very small aneurysms with a maximal diameter of 3 mm or less. We conducted a retrospective analysis of angiographic and clinical outcome following coiling of very small aneurysms and subsequently comparing it to the results of larger aneurysms. </jats:p><jats:p> Coiling initially failed in eight aneurysms. In the remaining 103 aneurysms endovascular treatment was accomplished and immediate angiographic results showed complete aneurysm occlusion in 43 aneurysms, nearly complete aneurysm occlusion in 54 aneurysms and less than 90% aneurysm occlusion in six aneurysms. Complications occurred in the treatment of 15 aneurysms, including eight procedural ruptures, six thromboembolic events and one case of early hemorrhage. Compared with larger aneurysms, treatment of very small aneurysms was associated with a higher rate of procedural ruptures (7.2% versus 4.4%) and procedural mortality (4.7% versus 2.7%) but a lower procedural morbidity (1.9% versus 4.0%). However none of these differences reached statistical significance (p = 0.186, p= 0.388, respectively). The retreatment rate was higher for the larger aneurysms (8.2% and 6.3%), but this was not significant either (p= 0. 496). At nine-month follow-up significantly more small aneurysms were found to have a stable occlusion grade compared to large aneurysms. </jats:p><jats:p> Endovascular treatment of very small aneurysms is feasible with a lower retreatment rate compared to large aneurysms (&gt; 3 mm). However the data also suggest that endovascular treatment of very small aneurysms might be associated with an increased risk of procedural ruptures and mortality. At nine-month follow-up results indicate significantly less compaction in the very small aneurysms. </jats:p>

Endovascular Coiling as the First Treatment Strategy for Ruptured Pericallosal Artery Aneurysms: Results, Complications, and Follow Up

“…Of these, 27 patients were successfully treated with endovascular coiling. Times elapsing between SAH and aneurysm repair were: º8 hours (6 cases), AE8 hours to º24 hours (4), AE24 hours to º2 days (11), and AE2 days (9). Bolus heparin was injected in 20 cases to maintain activated clotting time at 1.5-2.0 times the baseline throughout the procedure while heparin was delivered only via the catheter pressure infusion systems in the remaining 10 cases.…”

Endovascular Treatment of Very Small Intracranial Aneurysms: Meta-Analysis

“…1,2 Despite endovascular treatment being safe with low morbidity and mortality rates, in certain groups of aneurysms, a detailed risk-benefit assessment of this treatment must be considered. 3 Coil embolization of very small IAs (Յ3 mm) is particularly challenging due to the thin fragile wall of small IAs, with limited space to obtain a stable microcatheter position for coil deployment. [4][5][6] In the Barrow Ruptured Aneurysm Trial, very small aneurysm size was one of the main reasons for the high crossover rate from the coiling to the clipping group.…”

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

“…According to different reports, endovascular treatment of very small (≤3 mm) ruptured aneurysms is associated with a higher risk of complications, especially IPR and consequent rebleeding [10,11,12]. This can be due to the lack of microcatheter insertion space and structural limitations of current microcatheters and coils for coiling of very small aneurysms [6].…”