[Ruptured Cerebral Aneurysm:Endovascular Techniques and Devices]

Coil embolization remains the first-line treatment for ruptured aneurysms. Coil embolization alone has limitations for wide-neck aneurysms. On the other hand, devices implanted in the parent vessel, such as coil-assisted stents and flow diverters, require antiplatelet therapy; therefore, intrasaccular devices are likely to be the mainstay in ruptured cases. Currently, developed intrasaccular embolization devices are limited in size and require large-diameter catheters for guidance. Recently, the Woven EndoBridge device has been reported to work well and may be used in an increasing number of patients in the future. For large/giant aneurysms, staged embolization may improve the curative effect. Various hydrophilic metal coating techniques have been developed that may reduce the use of antiplatelet agents; however, sufficient data for ruptured cases have not been obtained.