Abstract
Objectives: Small aneurysmal size is a risk factor for procedure-related rupture during coil embolization and the treatment of small aneurysms is still controversial. We evaluated 13 small aneurysms treated by coil embolization, and discussed the technical aspects, safety and angiographic follow-up outcomes of the treatment. Moreover, the volume rate and duration of procedures were evaluated comparing the treatment with only Guglielmi detachable coil (GDC) and the treatment with newer coils with or without GDC.
Methods: Between February 2005 and February 2009, 97 aneurysms were embolized with coils. Of those 97 aneurysms, thirteen small aneurysms with a maximum diameter of 3mm were found in twelve patients and included in this study. These aneurysms comprised 8 ruptured and 5 unruptured aneurysms. Treatment outcome, procedure-related complications and completeness of occlusion during the follow-up period were investigated in relation to the kind and characteristics of the coils.
Results: All 13 small aneurysms could be embolized. Follow-up period was 22.8 months. Complications were one procedure-related rupture and one thrombo-embolism. There was no rupture of occluded aneurysms during the follow-up period. Of the 13 aneurysms, 5 were completely occluded, and 8 were incompletely occluded on the angiogram just after the procedure. Incompletely-occluded 4 aneurysms showed progression to complete occlusion on the follow-up angiogram. The mean duration of procedure was reduced and the mean volume embolization rate increased when embolized with newer coils than GDC.
Conclusions: Although endovascular coil embolization of small aneurysms still holds a high risk of procedure-related rupture, the technical and material improvement has enabled us in the last few years to treat them more safely and simply.
