Strategies and outcomes for coiling very small aneurysms.
OBJECTIVE
Coiling of aneurysms 3 mm in diameter or less has been associated with a relatively high rate of complications, including iatrogenic rupture. The present study aimed to determine the clinical outcome of our technique for coiling small aneurysms.


METHODS
A retrospective chart review was performed of prospectively collected data for all patients who had endovascular coiling of an aneurysm 3 mm in diameter or less between 2003 and 2008. Follow-up imaging with magnetic resonance or catheter angiography was performed at varying intervals after coiling, ranging from 1 to 6 years after the procedure. Angiographic results were assessed using the Raymond-Roy (RR) grading system. Clinical outcomes during the same period were measured using the modified Rankin Scale.


RESULTS
Between March 2003 and April 2008, 20 patients underwent coil embolization of an aneurysm 3 mm or smaller--17 ruptured and 3 unruptured. After the procedure, 10 aneurysms were completely occluded (RR 1), 7 had residual filling of the neck (RR 2), and 3 had residual filling of the fundus (RR 3). There were no iatrogenic ruptures. Stent assistance was used in three cases. Balloon assistance was not used. Two patients were retreated, but no aneurysm reruptured. Clinical outcomes were as expected on the basis of the presenting Hunt & Hess grade. One patient with a ruptured aneurysm died from complications related to severe vasospasm.


CONCLUSIONS
Aneurysms 3 mm in diameter or smaller can be coiled safely with the use of both bare platinum and hydrogel-coated coils. In most cases, coiling of small aneurysms can be performed without the use of adjunctive devices such as balloons or stents.
Division of Neurosurgery, Albany Medical Center, Albany, New York, USA.
John
J
Dalfino
Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Anil K
AK
Nair
Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Doniel
D
Drazin
Division of Neurosurgery, Albany Medical Center, Albany, New York, USA.
Edward
E
Gifford
Division of Neurosurgery, Albany Medical Center, Albany, New York, USA.
Neal
N
Moores
Division of Neurosurgery, Albany Medical Center, Albany, New York, USA. Electronic address: BoulosA@mail.amc.edu.
Alan S
AS
Boulos
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057785:Catheters; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D057832:Watchful Waiting
Cerebral angiography; Cerebrovascular disorders; Embolism and thrombosis; Endovascular procedures; Intracranial aneurysm; Neuroradiology; Retrospective studies; Treatment outcome; Watchful waiting