[Endovascular therapy options for aneurysmal subarachnoid hemorrhage]

Area of Science:

• Neurology
• Neurosurgery
• Interventional Radiology

Context:

• Aneurysmal subarachnoid hemorrhaging (ASH) presents significant clinical challenges and complications.
• Diagnostic modalities include CT, MRA, and DSA for aneurysm detection.
• Treatment options historically included surgical clipping and endovascular coiling.

Purpose:

• To review the efficacy and advancements in endovascular treatment for aneurysms.
• To compare endovascular coiling with neurosurgical clipping.
• To highlight the evolving role of endovascular techniques in managing ASH.

Summary:

• Endovascular embolization using platinum coils, including Guglielmi detachable coils, has advanced significantly since 1991.
• Complex aneurysm morphologies, previously requiring surgery, are now treatable with techniques like balloon remodeling and stent-assisted coiling.
• The International Subarachnoid Aneurysm Trial (ISAT) demonstrated superior outcomes with endovascular treatment over surgical clipping, establishing it as the primary therapeutic choice.

Impact:

• Endovascular treatment is now the recommended first-line therapy for both symptomatic and asymptomatic aneurysms when feasible.
• Despite a slightly higher re-bleeding rate, endovascular approaches yield better long-term patient results, as confirmed by 5-year follow-up data.
• Technological innovations continue to expand the applicability of endovascular methods in cerebrovascular neurosurgery.