Endovascular reconstruction of aneurysms with a complex geometry

Area of Science:

• Neurology
• Interventional Radiology
• Neurosurgery

Background:

• Conventional endovascular coiling is the primary treatment for most aneurysms.
• Complex or wide-necked aneurysms pose treatment challenges due to unfavorable morphology.
• Recanalization remains a risk with traditional coiling methods.

Purpose of the Study:

• To review and discuss current evidence for endovascular strategies in treating complex intracranial aneurysms.
• To highlight advancements in endovascular technology for challenging aneurysm geometries.
• To address the lack of consensus in managing specific complex aneurysm subtypes.

Main Methods:

• Literature review of endovascular treatment strategies for complex aneurysms.
• Discussion of techniques including balloon remodeling and stent-assisted coiling.
• Analysis of the role of flow diverters in endoluminal reconstruction.

Main Results:

• Balloon remodeling improves coil packing in wide-necked and large aneurysms.
• Self-expanding stents retain coils and redirect blood flow.
• Flow diverters are increasingly used for complex geometries, shifting focus to endoluminal reconstruction.

Conclusions:

• Newer endovascular techniques offer improved outcomes for complex aneurysms.
• Specific challenges remain for large/giant internal carotid, blister, and vertebrobasilar artery aneurysms.
• Further research is needed to establish optimal endovascular management for challenging aneurysm subsets.