Endovascular Treatment of Intracranial Aneurysms

Abstract

An intracranial aneurysm is a benign disorder that causes patients to have neurological deficits or to die. The sequelae develop because aneurysms rupture into the subarachnoid space or compress nervous tissue. Intracranial aneurysms occur in up to 8% of the population, more commonly in women, and the only modifiable risk factor for hemorrhage is cigarette smoking. Treatment is directed at the prevention of rupture or rebleeding and relief of mass effect. Surgical clipping has been the primary treatment, but in the past 6 years, endovascular therapy (Guglielmi detachable coil® [GDC]) has become widely available. Initially GDC treatment was directed at the nonsurgical candidate but recently has begun to compare with surgical clipping as a definitive mode of therapy. The primary consideration for successful GDC treatment of an aneurysm is the relationship of the aneurysm to its parent vessel and any branches. The size of the aneurysm dome in relation to the aneurysm neck, presence of thrombus, and the inflow zone are also significant factors. Coil compaction and aneurysm remnants at its neck are significant problems in GDC treatment. The technique and instruments are constantly improving: development of the remodeling technique; the introduction of softer, stretch-resistant coils; and the use of flexible coronary stents have permitted successful treatment of patients who once would have been considered poor candidates for this mode of therapy. Future development of more compliant balloons, coated coils, and liquid embolics will extend and improve endovascular therapy for patients with intracranial aneurysms.Objectives: Upon completion of this article, the reader should be able to understand and discuss (1) the significance of intracranial aneurysm and subarachnoid hemorrhage, (2) the modern means of evaluating patients with intracranial aneurysms, (3) the current methods of treatment, and (4) possible future methods of treatment. Accreditation: Tufts University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. TUSM takes full responsibility for the content, quality, and scientific integrity of this continuing education activity. Credit: Tufts University School of Medicine designates this education activity for a maximum of 1.0 hours credit toward the AMA Physicians Recognition Award in category one. Each physician should claim only those hours that he/she actually spent in the educational activity.Downloaded by: Universite Laval. Copyrighted material.