Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Abstract

The present study assessed the safety and efficacy of embolization using Guglielmi detachable coils (GDCs) in 100 asymptomatic cerebral aneurysms classified as sidewall (70) or terminal (30) aneurysms according to the parent artery (68 small aneurysms with a small neck, 21 small aneurysms with a wide neck, and 11 large aneurysms). A balloon-assisted technique was used in 49 aneurysms. Immediate angiography revealed that 71 aneurysms were completely obliterated. Transient deficits occurred in 19 patients, permanent deficits in four patients, and one patient died. Most complications occurred during or immediately after treatment and resolved within a few minutes to a few weeks. None of the surviving patients manifested significant morbidity at 1-year follow up. Follow-up angiographic study was performed in 79 aneurysms. Rates of recanalization and progressive thrombosis (total occlusion of the residual aneurysm at follow up) were 11% and 38%, respectively, in sidewall aneurysms, and 26% and 0%, respectively, in terminal aneurysms. Treatment with GDCs was effective for patients with small aneurysms with small necks, the morbidity was acceptable, and progressive thrombosis occurred during the follow-up period. GDC treatment achieved unsatisfactory results in patients with small terminal aneurysms with wide necks and in large aneurysms, because the obliteration rate was low, and the recanalization and complication rates were high. Multivariate analysis showed that complete occlusion was associated with small-necked aneurysms, and ischemic events tended to occur in terminal aneurysms and in aneurysms treated by the balloon-assisted technique.

Clinical and angiographic outcome in patients with completely occluded intracranial aneurysms by endovascular coiling: our experience

“…In the early stages after SAH, coiling protects against early rebleeding 7. Coil embolization may more successfully induce flow stagnation and promote thrombus formation in tightly packed aneurysms than in partially occluded ones, because blood flow renders partial occluded aneurysms ‘unstable’ for thrombosis 4. For aneurysms that are not tightly packed, GDCs are exposed to the ‘water hammer effect’, which is responsible for aneurysmal regrowth 8.…”

“…Endovascular coiling has been shown to be effective in the treatment of aneurysmal rupture as well preventing such a complication 3 4. This is achieved by direct coil packing as well as aneurysmal thrombosis induced by coils and blood stagnation, causing mechanical exclusion of the intra-aneurysmal blood flow.…”

“…This is achieved by direct coil packing as well as aneurysmal thrombosis induced by coils and blood stagnation, causing mechanical exclusion of the intra-aneurysmal blood flow. It is well known that direct packing of coils plays a more important role than thrombosis 4. However, only a few series in the English literature have addressed the benefits and outcome of achieving complete occlusion of IAs.…”

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

“…278 However, other authors have identified increased rates of cerebral ischemia when using a balloon-remodeling technique, especially when assessed with advanced imaging techniques such as MRI with diffusion. 264,294 Endovascular stents represent a departure from the endosaccular occlusion paradigm, because prosthetic material now lies in the normal vessel adjacent to the aneurysm. A number of single-center retrospective studies have reported increased rates of progressive aneurysm occlusion with the use of stents.…”

Complete Obliteration of a Basilar Artery Aneurysm after Insertion of a Self-Expandable Leo Stent into the Basilar Artery without Coil Embolization

“…Although planned coils embolization was not attempted, the patient was secured against rebleeding. Though patients with wide-necked aneurysms have another option of endovascular treatment (the use of the balloon-assisted technique), it is not recommended for aneurysms on the basilar artery (6). Total occlusion of the aneurysmal sack is difficult to achieve without unexpected occlusion of the parent artery (6).…”