AJDRAJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 2009;30:308.

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1374

INTERVENTIONAL

Coil Embolization of Very Small (2 mm or Smaller) Berry Aneurysms: Feasibility and Technical Issues

V. Gupta, M. Chugh, A.N. Jha, B.S. Walia and S. Vaishya

From the Departments of Interventional Neuroradiology (V.G., M.C.) and Neurosurgery (A.N.J., B.S.W., S.V.), Max Superspeciality Hospital, New Delhi, India.

Please address correspondence to Vipul Gupta, Interventional Neuroradiology, Department of Neurosurgery, Max Superspeciality Hospital, 1 Press Enclave Rd, Saket, New Delhi, India 110017; e mail: vipulgupta25{at}yahoo.com

BACKGROUND AND PURPOSE: The very small size of cerebral aneurysms is considered to be one of the limitations for endovascular treatment, with a high risk for intraoperative rupture. We report on treatment of very small saccular ruptured cerebral aneurysms by coil embolization. All the cases were of 2-mm aneurysms with at least 1 of the dimensions being less than 2 mm.

MATERIALS AND METHODS: We performed retrospective analysis of 7 consecutive cases of very small aneurysms treated by coil embolization in our institution between July 2006 and April 2008.

RESULTS: 3D rotational angiography (3DRA) was found to be most accurate in the detection of these aneurysms; in 2 cases, 3DRA revealed the aneurysms after results on digital subtraction angiography (DSA) were considered to be negative. Coil embolization was successfully performed in 6 cases, whereas in 1 case, spontaneous thrombosis occurred after microcatheter placement. Complete (n = 5) or near complete (n = 2) immediate occlusion was seen. A single soft coil was used in all cases with the shortest available length. Balloon assistance was used in 3 cases. Although minimal coil projection in the parent vessel was seen in 3 cases, no untoward clinical complication was seen. Follow-up DSA and MR angiography in 4 patients demonstrated persistent occlusion (n = 3) or progressive thrombosis (n = 1) of the aneurysms. All of the patients with available follow-up are independent in day-to-day activities with a modified Rankin Score (mRS) of 0 or 1.

CONCLUSIONS: Coil embolization of very small ruptured cerebral aneurysms is feasible. Careful consideration of the technical issues in treatment of these cases is essential to achieve technical success while avoiding complications.






Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X