Endovascular treatment of ruptured tiny aneurysms

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.

Clinical observation of coil embolization of ruptured tiny intracranial aneurysms / 中国脑血管病杂志

Objective: To investigate the feasibility and efficacy of endovascular embolization of ruptured tiny intracranial aneurysms. Methods: The clinical data of 11 patients with ruptured tiny intracranial aneurysm were analyzed retrospectively. All the patients with subarachnoid hemorrhage (SAH) were diagnosed by CT and microcoil embolization was performed after being confirmed by digital subtraction angiography (DSA). Results: Circled digit oneNine patients had anterior communicating artery aneurysm, 1 had anterior choroidal artery aneurysm, and 1 had pericallosal artery aneurysm. At admission, the Hunthess grade I was 3 cases, grade II was 5, grade III was 2, and grade IV was 1. Circled digit twoAll the patients were embolized successfully, 6 of them were embolized completely, and 5 were embolized incompletely (during 3 to 6 months DSA follow-up, they were all obliterated completely). The GOS were 5 in 9 patients, GOS 4 in 1 patient, and 1 patient died after the procedure. No technology-related complications were observed. Circled digit threeAt 3 to 6 months after procedure, 6, 2, and 2 patients were followed up with DSA, magnetic resonance angiography (MRA) or telephone respectively. The aneurysms were all obliterated completely, the GOS were 5 in all patients, and no rebleeding occurred. Conclusion: Endovascular embolization of ruptured tiny intracranial aneurysms in intracranial anterior circulation is safe and feasible, and the result of short-term follow-up is good.