title: The feasibility and efficacy of endovascular treatment for very small or tiny ruptured paraclinoid aneurysms.
abstract: BACKGROUND
  The aim of this study was to evaluate the feasibility of endovascular treatment (EVT) for ruptured very small (≤5 mm) or tiny (≤3 mm) paraclinoid aneurysms of the internal carotid artery (ICA).
  
  
  METHODS
  From November 2009 to April 2012, 32 ruptured paraclinoid aneurysms (very small, 23; tiny, 9) in 31 patients received EVT. Angiographic follow-up determined occlusion rates which were classified as total/near-total (95-100 %), subtotal (80-95 %), and partial (<80 %) occlusions. Follow-up data were retrospectively analyzed and categorized using the Modified Rankin Scale (mRS).
  
  
  RESULTS
  Based on our paraclinoid aneurysm classification, 25 % (8) were classified as type I, 46.9 % (15) as type II, and 28.1 % (9) as type III. EVT was technically successful in 96.8 % (31), with coiling only in 12.5 % (4), balloon remolding coiling in 6.3 % (2), and stent-assisted coiling in 78.1 % (25). Total/near-total occlusion was immediately achieved in 34.4 % (11), subtotal occlusion in 37.5 % (12), and partial occlusion in 28.1 % (9). Follow-up angiography (mean, 9.9 ± 6.4 months) revealed total/near-total occlusion in 50 % (16) aneurysms, subtotal in 31.3 % (10), and partial occlusion in 18.8 % (6). At the end of clinical follow-up (mean, 14.8 ± 9.5 months), it revealed an mRS grade 0 in 38.7 % (12) of patients, grade 1 in 25.8 % (8), grade 2 in 22.6 % (7), grade 3 in 6.5 % (2), grade 4 in 3.2 % (1), and grade 5 in 3.2 % (1).
  
  
  CONCLUSIONS
  EVT is feasible and effective for ruptured very small or tiny paraclinoid aneurysms of the ICA.
authors.affiliation: Department of Neurosurgery, The Second Affiliated Hospital, Medical School of Zhejiang University, No. 88, Jie Fang Road, Hangzhou 310009, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
authors.forename: Xian-Yi
authors.initials: XY
authors.lastname: Chen
authors.forename: Ding-Yao
authors.initials: DY
authors.lastname: Jiang
authors.forename: Wen
authors.initials: W
authors.lastname: Li
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome