Tiny intracranial aneurysms: Endovascular treatment by coil embolisation or sole stent deployment

• Published in: European journal of radiology Vol. 81; no. 6; pp. 1276 - 1281
• Main Authors: Lu, Jun, Liu, Jia-chun, Wang, Li-jun, Qi, Peng, Wang, Da-ming
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.06.2012
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - pathology; Aneurysm, Ruptured - therapy; Catheterization; Cerebral Angiography; Coils; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Endovascular treatment; Female; Humans; Intracranial aneurysm; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - pathology; Intracranial Aneurysm - therapy; Male; Middle Aged; Radiology; Stents; Stents - adverse effects; Tiny; Treatment Outcome; PCoA; Coils; posterior communicating artery; bifurcation of internal carotid artery; Tiny; posterior inferior cerebellar artery; ACoA; GDCs; International Study of Unruptured Intracranial Aneurysms; Intracranial aneurysm; Guglielmi detachable coils; Stents; vertebral artery; Endovascular treatment; AChA; ICA bifurcation; ISUIA; Glasgow Outcome Scale; MCA; GOS; VA; middle cerebral artery; PICA; anterior choroidal artery; subarachnoid hemorrhage; the International Subarachnoid Hemorrhage Trial; SAH; anterior communicating artery; ISAT
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2011.03.005

Abstract Purpose Tiny intracranial aneurysms pose a significant therapeutic challenge for interventional neuroradiologists. The authors report their preliminary results of endovascular treatment of these aneurysms. Methods Between January 2002 and December 2009, 52 tiny intracranial aneurysms (defined as ≤3 mm in maximum diameter) in 46 patients (22 men; mean age, 57.9 years) were treated by endosaccular coil embolisation or sole stent deployment in the parent artery. Of 52 aneurysms, 29 had ruptured and 23 remained unruptured. The initial angiographic results, procedural complications, and clinical outcomes were assessed at discharge. Imaging follow-up was performed with cerebral angiography. Results One aneurysm coiling procedure failed because of unsuccessful micro-catheterization. Forty-three aneurysms were successfully coil embolized, of which complete occlusion was obtained in 14, subtotal occlusion in 18 and incomplete occlusion in 11. The other 8 aneurysms were treated by sole stent deployment in the parent artery. Procedural complications (2 intraprocedural ruptures and 3 thromboembolic events) occurred in 5 (9.6%) of 52 aneurysms, resulting in permanent morbidity in only 1 (2.2%, 1/46) patient. No rebleeding occurred during clinical follow-up (mean duration, 46.7 months). Of the 16 coiled aneurysms that receiving repetitive angiography, 6 initially completely and 3 subtotally occluded aneurysms remained unchanged, 4 initially subtotally and 3 incompletely occluded aneurysms progressed to total occlusion. Five sole stent deployed aneurysms received angiographic follow-up (mean duration, 10.0 months), of which 3 remained unchanged, 1 became smaller and 1 progressed to total occlusion. Conclusion Endovascular treatment of tiny intracranial aneurysms is technical feasible and relatively safe. Coil embolisation seems to be effective in preventing early recanalisation, whereas sole stenting technique needs further investigation to determine its effectiveness.