title: Endovascular therapeutic strategies in ruptured intracranial aneurysms.
abstract: The aim of the present study was to evaluate endovascular techniques used currently which were not available at the time of ISAT inclusion period, such as balloon remodelling and flow-divertion, in order to assess whether these new technologies have improved the endovascular approach outcomes. We present a review of articles, published in major journals, with the aim to evaluate the efficacy and the safety of coiling with balloon remodelling for the treatment of ruptured aneurysms in comparison to coiling performed without such coadjutant techniques. Furthermore, we reviewed publications reporting on the treatment of ruptured aneurysms in the acute phase with the one of the most recent technologies available nowadays: the flow diverting stent. Looking at the recent literature the results regarding ruptured aneurysms treated with balloon assisted coiling (BAC) have shown an improvement in terms of anatomical results and morbi-mortality rates. Case series of ruptured middle cerebral artery (MCA) aneurysms treated by EVT report results similar to those obtained by surgical clipping. Several articles recently report encouraging results in treating ruptured dissecting and blister aneurysms with flow diverters. Questions regarding the best treatment available for ruptured aneurysms are yet to be answered. Hence there is a need for a subsequent trial aiming to answer these unresolved issues.
authors.affiliation: CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France. paolo.machi@gmail.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Machi
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Lobotesis
authors.forename: Jean Francoise
authors.initials: JF
authors.lastname: Vendrell
authors.forename: Carlos
authors.initials: C
authors.lastname: Riquelme
authors.forename: Omer
authors.initials: O
authors.lastname: Eker
authors.forename: Vincent
authors.initials: V
authors.lastname: Costalat
authors.forename: Alain
authors.initials: A
authors.lastname: Bonafe
mesh_terms: D017542:Aneurysm, Ruptured / Q000401:mortality* / Q000628:therapy; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D015984:Causality; D002548:Cerebral Revascularization / Q000401:mortality*; D057510:Endovascular Procedures / Q000401:mortality*; D019317:Evidence-Based Medicine; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality* / Q000628:therapy*; D015995:Prevalence; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D015996:Survival Rate
keywords: Aneurysm clipping; Assisted balloon remodelling technique; Cerebral angiography; Endovascular coiling; Ruptured cerebral aneurysms; Subarachnoid hemorrhage