Outcome in small aneurysms (<4 mm) treated by endovascular coiling

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Coiling small brain aneurysms (≤4 mm) presents technical challenges compared to larger ones.
• Operator perception often dictates treatment decisions for small aneurysms.
• A need exists to evaluate the safety and efficacy of coiling small aneurysms.

Purpose of the Study:

• To assess the feasibility and outcomes of endovascular coiling for small intracranial aneurysms.
• To compare intraprocedural rupture rates and long-term durability between small and non-small aneurysms.
• To evaluate complication rates and clinical outcomes in small aneurysm coiling.

Main Methods:

• Retrospective review of 360 intracranial aneurysms treated between 2003 and 2008.
• Selection of a control group of non-small aneurysms matched for age and location.
• Analysis of intraprocedural rupture, recanalization, and retreatment rates.

Main Results:

• Intraprocedural perforation rates were 12% for small and 4% for non-small aneurysms (p=0.22), with good outcomes in small aneurysm perforations.
• Recanalization was significantly lower in small aneurysms (9%) compared to non-small ones (33%) (p=0.006).
• No retreatments were required for small aneurysms, versus 7% for non-small aneurysms (p=0.116).

Conclusions:

• Endovascular coiling is a feasible treatment for small intracranial aneurysms with acceptable complication rates.
• Although intraprocedural rupture is not significantly increased, it does not lead to higher morbidity.
• Coiling small aneurysms provides durable, long-term results, making it a reliable therapeutic option.