Does Small Aneurysm Size Predict Intraoperative Rupture during Coiling in Ruptured and Unruptured Aneurysms?

Immediate and follow-up results for 44 consecutive cases of small (<10 mm) internal carotid artery aneurysms treated with the pipeline embolization device

“…A significant advantage of the endoluminal approach is avoidance of the most feared risk of intraprocedural aneurysm rupture during access or coil placement inherent to endosaccular techniques. [2202229] For unruptured aneurysms, this intraprocedural rupture risk ranges from 1.2% to 4%[162429] and is associated with high rates of morbidity and mortality. The combined risk of permanent neurologic disability and death associated with intraprocedural rupture is as high as 29% for unruptured aneurysms.…”

“…[4] Small aneurysm size is a known risk factor for intraprocedural rupture and well documented in the literature. [2202224] For aneurysms 6 mm or smaller, this risk approaches 5%[2202224] with an estimated mortality ranging from 1% to 16.7%[202429] and major morbidity of 27.8%. [24] Considering this risk profile for treating small aneurysms with endosaccular techniques, the 2.3% major morbidity and mortality reported in this series of PED treatment for small ICA aneurysms supports an endoluminal approach as a valid alternative.…”

“…[13142634] Treatment of small aneurysms (<10 mm) with flow diverters may be advantageous over endosaccular modalities, which inherently carry a risk of procedural rupture during access of the aneurysm sac or coil placement. [2202229] Specific data regarding the procedural, angiographic, and clinical outcomes of PED treatment in small aneurysms is limited in the literature and commonly reported in conjunction with series on large and giant aneurysms. [12182730]…”

Predicting intraprocedural rupture and thrombus formation during coiling of ruptured anterior communicating artery aneurysms

“…Small aneurysms are a well-known risk factor for the rupture complication. Mitchell et al 22 reported that aneurysms of ≤4 mm were an important risk factor for intraprocedural rupture. However, we found that the threshold of aneurysm size separating rupture and non-rupture groups was 3.5 mm in ruptured ACoA aneurysms.…”

Comparison of Clinical Outcomes of Intracranial Aneurysms: Procedural Rupture versus Spontaneous Rupture

“…viously reported, 1,[3][4][5][6][7][8][9] the clinical prognosis of pure PR remains unclear because the reports included ruptured aneurysms, hindering the assessment of the harmful influence of PR. In addition, there have been various treatment guidelines in unruptured intracranial aneurysms (UIAs), [10][11][12][13][14] and some argue that no treatment might be cost-effective in some clinical situations.…”