Aneurysm-Rainbow Team/HelsinkiEndovascular treatment of very small intracranial aneurysms
Introduction
With the development of endovascular devices and techniques recently, endovascular treatment has became a standard method for the treatment of intracranial aneurysms. However, for very small aneurysms with maximal diameter less than 3 mm, safety and efficiency of endovascular treatment is still controversial. Direct clipping is also limited because these aneurysms are often thin-walled and carry the risks of narrowing or tearing the parent vessel during clipping [14]. In the present study, we retrospectively reviewed our endovascular management of very small aneurysms in 11 patients, with an assessment of its efficacy and safety.
Section snippets
Population
From October 2001 to August 2006, 11 very small aneurysms with maximal diameter of 3 mm or less from 11 consecutive patients were included in this study. Another case with very small AcomA aneurysm, despite having been initially chosen for embolization, was not included in this series because microcatheter could not be navigated through the anterior cerebral artery with severe vasospasm.
As shown in Table 1, the patient group consisted of 3 female and 8 male patients with a mean age of 43 years
Endovascular treatment
Microcatheters were successfully inserted into aneurysms sac in 6 AcomA aneurysms (Fig. 1) and 1 VA-PICA aneurysm, and the aneurysms were completely obliterated with only 1 (4 aneurysms) or 2 (3 aneurysms) coils.
In 2 of the 3 patients chosen for stent-assisted procedures, we were capable of introducing the microdelivery stent systems to the desired location and deploying the stents without displacement in the first session. In the remaining patient with bilateral supraclinoid ICA aneurysms, the
Discussion
It has been reported that ruptured small aneurysms may cause even more extensive SAH than larger aneurysms [18]. Unruptured small aneurysms with a previous hemorrhage from another aneurysm were suggested to have much higher risk of rupture than those without previous hemorrhage. Consequently, effective treatment is usually pursued for those lesions. Forget et al [5] reviewed 245 cases of ruptured aneurysms and found that 86 cases (35%) were smaller than 5 mm, of which anterior communicating
Conclusion
Endovascular treatment may be a feasible and effective therapeutic alternative for very small aneurysms. The long-term efficacy and durability of endovascular treatment of these lesions remains to be determined in a large series.
References (22)
- et al.
Long-term clinical and radiologic results of small cerebral aneurysms embolized with 1 or 2 detachable coils
Surg Neurol
(2006) - et al.
Balloon-expandable stenting with and without coiling for wide-neck and complex aneurysms
Surg Neurol
(2006) - et al.
Feasibility and limitations of endovascular coil embolization of anterior communicating artery aneurysms: morphological considerations
Neurosurgery
(2006) - et al.
Surgical management of distal coil migration and arterial perforation after attempted coil embolization of a ruptured ophthalmic artery aneurysm: technical case report
Neurosurgery
(2006) - et al.
Double-stent method: therapeutic alternative for small wide-necked aneurysms. Technical note
J Neurosurg
(2004) - et al.
Usefulness of the Neuroform stent for the treatment of cerebral aneurysms: results at initial (3-6–mo) follow-up
Neurosurgery
(2005) - et al.
A review of size and location of ruptured intracranial aneurysms
Neurosurgery
(2001) - et al.
Absent relationship between the coil-embolization ratio in small aneurysms treated with a single detachable coil and outcomes
AJNR Am J Neuroradiol
(2005) - et al.
Stent-assisted coil embolization of intracranial wide-necked aneurysms
Neuroradiology
(2005) - et al.
Histological postmortem study of an internal carotid artery aneurysm treated with the Neuroform stent
Neurosurgery
(2005)