Original ArticleProgressive Occlusion and Recanalization After Endovascular Treatment for 287 Unruptured Small Aneurysms (<5mm): A Single-Center 6-Year Experience
Introduction
Despite great technologic improvements and the published results of The International Study of Unruptured Intracranial Aneurysms (ISUIA), the endovascular treatment of small unruptured intracranial aneurysms (UIAs) has still been debated regarding the indication and use of endovascular treatment as a preventive treatment modality.1, 2, 3 There is no evidence confirming the long-term natural history of small UIAs in unselected populations or advantages to their conservative management versus endovascular coil embolization.3, 4 The challenges of coiling a small UIA are related to the inability to obtain a stable microcatheter position, initial selection, or reselection during coil packing, and risk of intraprocedural rupture due to perforation from packing coils into a shallow, confined sac.5, 6, 7
Studies comparing the outcomes and complication rates between the endovascular treatment of small and large intracranial aneurysms have found a nonsignificant increase in the frequency of intraprocedural rupture, thromboembolism, and recanalization on angiographic follow-up with coiling of small aneurysms compared with larger aneurysms.7, 8, 9 However, no studies on single or multiple aneurysms have evaluated the factors related to the progressive occlusion and recanalization of small UIAs.
In the present study, we performed a retrospective review of 287 UIAs coiled at our institution to investigate the effect of coiling for small UIAs (<5 mm) on progressive occlusion and recanalization, factors related to progressive occlusion and recanalization among UIAs without complete occlusion were also investigated.
Section snippets
Study Population
In total, 287 consecutive patients undergoing endovascular coil embolization for small aneurysms at our institution between June 2009 and December 2014 were enrolled. The indication for treatment and its modality depended on interdisciplinary consensus between a vascular neurosurgeon and a neurointerventional specialist based on amenability to embolization considering factors such as irregular or with daughter sac, wide-neck, and bifurcation location. All patients in this study chose
Results
Between June 2009 and December 2014, 264 patients with 287 small UIAs underwent endovascular treatment at our institution. The patient inclusion flow chart is shown in Figure 1. Basic characteristics of included patients are shown in Table 1. Of 264 patients, 201 (71.1%) were women and 83 (28.9%) were men. The mean age of patients was 54.0 ± 9.4 years (range, 22–77 years).
Discussion
Our study included a large series of consecutive endovascular treatments of unruptured small aneurysms. These findings suggest that coil embolization of small aneurysms can be performed with acceptable rates of progressive occlusion and recurrence. However, our study also revealed that smaller size (<3 mm) was associated with recanalization in aneurysms that did not have a complete occlusion initially.
Endovascular coil embolization has become a widely accepted procedure used in the treatment of
Conclusions
Our study suggested that coil embolization of small UIAs can achieve a high rate of progressive occlusion and a low rate of recanalization during follow-up. However, treatment options for small aneurysm may should be more strict and thoughtful, because a recurrence rate of 5.7% and an almost 4% rate of mRS 3–6 (including 2 deaths) does not seem to be a perfect result for a series aneurysms that may have a low rupture rate per year. Anatomic results of initial and follow-up between small (3–5
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Conflict of interest statement: This research was supported by the Natural Science Foundation of Beijing, China (No.7142032), and Specific Research Projects for Capital Health Development (2014-3-2044).
Xin Feng and Luyao Wang contributed equally.