[Endovascular treatment for cerebral aneurysms]

Area of Science:

• Neurology
• Interventional Radiology
• Neurosurgery

Background:

• Endovascular therapy for cerebral aneurysms has advanced significantly since the introduction of Guglielmi detachable coils.
• The International Subarachnoid Aneurysm Trial (ISAT) demonstrated superior outcomes for endovascular coiling compared to neurosurgical clipping for ruptured aneurysms.

Purpose of the Study:

• To review the evolution and current state of endovascular therapy for cerebral aneurysms.
• To highlight advancements in coiling technology and adjunctive techniques.
• To discuss challenges and emerging treatments for complex aneurysms.

Main Methods:

• Review of endovascular techniques and devices for cerebral aneurysm treatment.
• Discussion of imaging modalities like digital subtraction angiography (DSA) and its role.
• Analysis of coil advancements, including 3D shaped, stretch-resistant, and bioactive coils.
• Exploration of adjunctive techniques like balloon and stent assistance.
• Consideration of emerging treatments such as flow-diverting stents and Onyx for large aneurysms.

Main Results:

• Endovascular coiling is widely adopted globally following ISAT findings.
• Advanced imaging (3D DSA, biplane systems) is crucial for procedural success.
• New coil designs and assisted techniques expand treatment options for challenging aneurysms.
• Bioactive coils promote aneurysm healing through tissue reaction.
• Very large and giant aneurysms remain difficult to treat with current coiling methods.

Conclusions:

• Endovascular therapy, particularly coiling, has become a cornerstone in cerebral aneurysm management.
• Technological innovations continue to enhance treatment efficacy and broaden applicability.
• Ongoing research and clinical trials are essential to address limitations, especially for large and complex aneurysms.