Endovascular treatment of ruptured tiny (≤3mm) intracranial aneurysms in the setting of subarachnoid hemorrhage: A case series of 20 patients and literature review

Miracle C. Anokwute, John A. Braca, Bradley Bohnstedt, Andrew DeNardo, John Scott, Aaron Cohen-Gadol, Daniel H. Sahlein

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Successful endovascular coiling of ruptured tiny saccular intracranial aneurysms (≤3. mm) is technically challenging and traditionally has been associated with technical failures, as well as morbidity related to thromboembolic events and high intraoperative rupture rates. This study analyzes the feasibility, technical efficacy, and clinical outcomes of coil embolization of ruptured tiny intracranial aneurysms using current coil and microcatheter technology and techniques. We performed a retrospective review of 20 patients with 20 ruptured tiny aneurysms treated with endovascular coil embolization from 2013 to 2016 at a single high-volume academic tertiary care practice. The mean aneurysm size was 2.4. mm (median 2.5. mm, 1-3). Complete occlusion was achieved in 12 of 20 patients (60%), the remaining 7 of 20 patients (35%) had a small neck remnant, and there was 1 failure (5%) converted to microsurgical clipping. Two patients had a failed attempted surgical clip reconstruction and were subsequently coiled. There was 1 intraprocedural rupture (5%) and 1 severe parent artery vasospasm (5%) during coiling. At discharge, 60% of patients were living independently. At follow-up three patients were deceased. Mean angiographic follow-up was 139. days (SD 120). There were no aneurysm recurrences among occluded patients and there were no retreatments among those with neck remnants. Coiling of ruptured aneurysms ≤3. mm is feasible with high occlusion rates and low complication rates. The availability of softer coils with flexible detachment zones has led to safe and effective endovascular treatment of tiny ruptured aneurysms.

Original languageEnglish (US)
JournalJournal of Clinical Neuroscience
DOIs
StateAccepted/In press - Oct 18 2016

Fingerprint

Intracranial Aneurysm
Subarachnoid Hemorrhage
Ruptured Aneurysm
Aneurysm
Therapeutics
Rupture
Neck
Retreatment
Feasibility Studies
Tertiary Healthcare
Surgical Instruments
Arteries
Technology
Morbidity
Recurrence

Keywords

  • 3mm
  • Endovascular
  • Subarachnoid hemorrhage
  • Tiny ruptured aneurysms

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Endovascular treatment of ruptured tiny (≤3mm) intracranial aneurysms in the setting of subarachnoid hemorrhage : A case series of 20 patients and literature review. / Anokwute, Miracle C.; Braca, John A.; Bohnstedt, Bradley; DeNardo, Andrew; Scott, John; Cohen-Gadol, Aaron; Sahlein, Daniel H.

In: Journal of Clinical Neuroscience, 18.10.2016.

Research output: Contribution to journalArticle

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abstract = "Successful endovascular coiling of ruptured tiny saccular intracranial aneurysms (≤3. mm) is technically challenging and traditionally has been associated with technical failures, as well as morbidity related to thromboembolic events and high intraoperative rupture rates. This study analyzes the feasibility, technical efficacy, and clinical outcomes of coil embolization of ruptured tiny intracranial aneurysms using current coil and microcatheter technology and techniques. We performed a retrospective review of 20 patients with 20 ruptured tiny aneurysms treated with endovascular coil embolization from 2013 to 2016 at a single high-volume academic tertiary care practice. The mean aneurysm size was 2.4. mm (median 2.5. mm, 1-3). Complete occlusion was achieved in 12 of 20 patients (60{\%}), the remaining 7 of 20 patients (35{\%}) had a small neck remnant, and there was 1 failure (5{\%}) converted to microsurgical clipping. Two patients had a failed attempted surgical clip reconstruction and were subsequently coiled. There was 1 intraprocedural rupture (5{\%}) and 1 severe parent artery vasospasm (5{\%}) during coiling. At discharge, 60{\%} of patients were living independently. At follow-up three patients were deceased. Mean angiographic follow-up was 139. days (SD 120). There were no aneurysm recurrences among occluded patients and there were no retreatments among those with neck remnants. Coiling of ruptured aneurysms ≤3. mm is feasible with high occlusion rates and low complication rates. The availability of softer coils with flexible detachment zones has led to safe and effective endovascular treatment of tiny ruptured aneurysms.",
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