Korean J Radiol.  2010 Oct;11(5):536-541. 10.3348/kjr.2010.11.5.536.

Endovascular Coil Embolization of Very Small Intracranial Aneurysms

• Chae KS
• Jeon P
• Kim KH
• Kim ST
• Kim HJ
• Byun HS

• KMID: 1102578
• DOI: http://doi.org/10.3348/kjr.2010.11.5.536

Abstract

OBJECTIVE
We aimed to evaluate the results of endovascular coil embolization for very small aneurysms (< or = 3 mm).
MATERIALS AND METHODS
Between March 2005 and December 2008, a total of 31 very small aneurysms in 30 patients were treated by coil embolization. Of the 31 aneurysms, five (16%) were ruptured, as opposed to 26 (84%) that were not. We assessed the procedural complications, immediate angiographic outcome after coiling, clinical outcome, and follow-up MR angiography (MRA).
RESULTS
Two thromboembolic complications occurred during the procedure, but did not lead to any persistent neurologic deficit. No procedural aneurysmal rupture was observed and procedure-related morbidity and mortality were both 0%. Occlusion was adequate in 25 aneurysms (81%) and incomplete in six aneurysms (19%). The clinical outcomes of five patients with ruptured aneurysms were good (Glasgow outcome scale > or = 4), with no bleeding of the treated aneurysms during a mean follow-up period of 13.3 months. On 27 follow-up MRA, there was no recurrence, and the five incompletely occluded aneurysms showed a spontaneous amelioration resulting in an adequate occlusion.
CONCLUSION
Coil embolization of very small aneurysms is technically feasible with good results. The long-term efficacy and the potential as a standard treatment strategy remain to be determined by randomized large trials.

Keyword

Intracranial aneurysm; Endovascular treatment; Outcome

MeSH Terms

Adult
Aged
Aged, 80 and over
Aneurysm, Ruptured/*therapy
Cerebral Angiography
Embolization, Therapeutic/*methods
Female
Humans
Intracranial Aneurysm/*therapy
Magnetic Resonance Angiography
Male
Middle Aged
Treatment Outcome

Figure

• 

  Fig. 1 Follow-up MR angiographic images in ages in 61-year-old woman. A. Roadmap image shows that microcatheter tip is in aneurysm on top of basilar artery. Another small aneurysm is noted between basilar artery and left superior cerebellar artery. B. Postembolization angiography shows contrast filling of residual aneurysmal sac, especially in dome of aneurysm. C. Source image of 3D TOF MRA on day following coil embolization depicts focal high signal intensity, thus suggesting residual arterial flow in embolized aneurysm (arrow). D. Source image of six month follow-up 3D TOF MRA shows loss of high signal intensity in embolized aneurysm (arrow).

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