title: Coiling of ruptured tiny cerebral aneurysms, feasibility, safety, and durability at midterm follow-up, and individual experience.
abstract: OBJECTIVE
  The tiny size of cerebral aneurysms represents one of the challenging facets for endovascular treatment, with a high risk for intraoperative rupture (IOR). We report on the treatment of tiny ruptured saccular cerebral aneurysms by coil embolization. All cases were that of £ 2-3 mm aneurysms with at least one of the dimensions < 2 mm.
  
  
  METHODS
  Between April 2008 and December 2010, we performed a retrospective analysis of nine consecutive cases of tiny aneurysms treated by coil embolization in our institution.
  
  
  RESULTS
  Coil embolization was successfully performed in nine cases, whereas in one case, intraoperative rupture (IOR) of the fundus was encountered before complete obliteration of the aneurysm expected to be achieved with two coils. Complete occlusion (in n = 7 aneurysms) or near-complete immediate occlusion (in n = 2 aneurysms) was achieved. A total of 18 coils was used for coiling of the nine aneurysms, wherein five aneurysms were coiled with two coils each, two aneurysms with three coils each, and two aneurysms with only one coil each to achieve accepted results. Balloon assistance was used in three cases. Although a minimal coil projection in the parent vessel was seen in three cases, no untoward clinical complications were seen. At mean follow-up (6.7 months, interquartile range (IQR) 3-12 months), digital subtraction angiography (DSA) and magnetic resonance angiography (MRA) in nine patients demonstrated persistent complete occlusion in six of the aneurysms; one aneurysm showed marked filling of the fundus, and two showed neck remnant but did not need retreatment. All patients with available follow-up were independent in day-to-day activities with a modified Rankin score (mRS) of 0 or 1.
  
  
  CONCLUSIONS
  Coil embolization of tiny ruptured cerebral aneurysms is feasible. Careful consideration of the technical issues in treatment of such aneurysms is essential to achieve technical success while avoiding complications.
authors.affiliation: Neurology Department, Alexandria University, Alexandria, Egypt. yassinossama@yahoo.com
authors.forename: O
authors.initials: O
authors.lastname: Mansour
authors.forename: M
authors.initials: M
authors.lastname: Megahed
authors.forename: M
authors.initials: M
authors.lastname: Schumacher
authors.forename: J
authors.initials: J
authors.lastname: Weber
authors.forename: M
authors.initials: M
authors.lastname: Khalil
mesh_terms: D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome