Intracranial aneurysm embolization

Intracranial Aneurysm Flow Diversion.

Since the emergence of the Guglielmi detachable coil in the late 1980s and early 1990s, intracranial aneurysm treatment has entered an endovascular era which has served as a crucial adjunct to the gold standard of microsurgical clipping. The International Subarachnoid Aneurysm Trial (ISAT) and International Study of Unruptured Intracranial Aneurysms (ISUIA) have established the exponential increase in utility of endovascular procedures for aneurysms treatment. Results of the ISAT showed that 1-yr disability or death occurred in 30.9% of patients treated via clipping vs only in 23.5% of patients in the coiling group 1)

With the increasing use of endovascular techniques in the treatment of both ruptured intracranial aneurysm and unruptured intracranial aneurysms, the issue of obliteration efficacy has become increasingly important.

Endovascular therapy is for certain aneurysms the treatment of choice for intracranial aneurysms (IAs) for its efficacy and safety profile. Still, many aneurysms such as large, giant, wide necked aneurysm, and fusiform aneurysms are considered more challenging and less amenable to traditional endovascular coiling 2).

In addition to coiling, balloon remodeling technique and Stent-assisted coiling have been employed for the endovascular treatment of wide-necked or otherwise morphologically challenging intracranial aneurysms, and each technique confers unique advantages. Flow-diverting stents may also be used as a primary treatment modality for complex aneurysms and have a number of benefits and limitations 3).

see Flow diverter

see Aneurysm Recanalization Stratification Scale.

Molyneux AJ, Kerr RS, Yu LM, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366(9488):809-817.
Leung GKK, Tsang ACO, Lui WM. Pipeline embolization device for intracranial aneurysm: a systematic review. Clin Neuroradiol (2012) 22:295–303.10.1007/s00062-012-0178-6
Raper DM, Crowley RW, Liu KC, Starke RM. Endovascular techniques and devices for the treatment of intracranial aneurysms: a review of neurointerventional outcomes. J Neurosurg Sci. 2015 Nov 25. [Epub ahead of print] PubMed PMID: 26606546.
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