Coiling for paraclinoid aneurysms: time to make way for flow diverters?

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Paraclinoid aneurysms are complex cerebrovascular lesions.
• Endovascular techniques are increasingly used for treatment.
• Flow diversion is an emerging strategy for these aneurysms.

Purpose of the Study:

• To evaluate the safety and efficacy of traditional endovascular coil treatment for unruptured paraclinoid aneurysms.
• To analyze complications and outcomes of coil embolization with or without adjunctive devices.
• To establish a baseline for comparison with newer techniques like flow diversion.

Main Methods:

• Retrospective review of 118 patients with 126 unruptured paraclinoid aneurysms treated between 1999 and 2010.
• Analysis of clinical records, endovascular reports, angiographic results, and patient outcomes.
• Categorization of aneurysms by location (carotid-ophthalmic, hypophyseal, etc.) and treatment assistance (balloon, stent).

Main Results:

• The majority of aneurysms were carotid-ophthalmic (59%).
• Technical complications causing permanent morbidity were rare (0.8%).
• Complete occlusion was achieved in 62% of aneurysms during follow-up, with good clinical outcomes in 95% of patients.

Conclusions:

• Modern endovascular coil treatment for unruptured paraclinoid aneurysms is a safe procedure.
• Satisfactory, though not ideal, rates of complete angiographic occlusion were observed.
• Future advancements, such as flow diversion, aim to improve occlusion rates while maintaining low complication profiles.