Unruptured Aneurysms-Endovascular Treatment

Kim, Hyo Chang; Kim, Young Woo; You, Seung Hoon; Kim, Seong Rim; Kim, Sang Don; Baik, Min Woo

Abstract

The management of unruptured aneurysm is controversial, and two main discussion points are its natural history and the role of endovascular coiling in the repair of this aneurysms. We reviewed our results of treatments using coil embolization for the unruptured intracranial aneurysms. We treated 106 unruptured aneurysms by endovascular coiling for the last 6 years. while 45 unruptured aneurysms were treated by clipping during same period. Seventy-six (71.7%) unruptured aneurysms were distributed in anterior circulation and 30 (28.3%) was in posterior circulation. Aneaurysms of paraclinoid carotid artery and vertebrobasilar artery was the most frequent location of endovascular coiling of UIAs and anticipated surgical difficulty was the most common reason for choosing coiling. Sixty-three (59.4%) aneurysms were smaller than 10 mm in maximum aneurysm size, 30 (28.3%) aneurysms were 11-20 mm, and 13 (12.2%) were over 21 mm. Complete embolization was achieved in 61 (57.5%) aneurysms, neck remnants in 35 (33.0%) aneurysms, incomplete embolization in 7 (6.7%), and attempted and failed was in three (2.8%). There were 9 procedural complications, 6 thromboembolisms, 2 aneurysm perforations and 1 coil migration. Three patients with thromboembolic complication and a coil migration patient remained in permanent neurologic deficit (morbidity : 3.8%). However, three thromboembolic complications and two aneurysm perforation recovered clinically well. In our series, small aneurysms (<10 mm) were involved larger number of preventive interventions of UIAs than large or giant size aneurysms. Although, over all morbidity and mortality of coil embolization for unruptured aneurysms in our series were low, the indications of repairing for small size unruptured aneurysms need to investigated further.