title: Endovascular treatment of ruptured tiny (⩽3mm) intracranial aneurysms in the setting of subarachnoid hemorrhage: A case series of 20 patients and literature review.
abstract: Successful endovascular coiling of ruptured tiny saccular intracranial aneurysms (⩽3mm) is technically challenging and traditionally has been associated with technical failures, as well as morbidity related to thromboembolic events and high intraoperative rupture rates. This study analyzes the feasibility, technical efficacy, and clinical outcomes of coil embolization of ruptured tiny intracranial aneurysms using current coil and microcatheter technology and techniques. We performed a retrospective review of 20 patients with 20 ruptured tiny aneurysms treated with endovascular coil embolization from 2013 to 2016 at a single high-volume academic tertiary care practice. The mean aneurysm size was 2.4mm (median 2.5mm, 1-3). Complete occlusion was achieved in 12 of 20 patients (60%), the remaining 7 of 20 patients (35%) had a small neck remnant, and there was 1 failure (5%) converted to microsurgical clipping. Two patients had a failed attempted surgical clip reconstruction and were subsequently coiled. There was 1 intraprocedural rupture (5%) and 1 severe parent artery vasospasm (5%) during coiling. At discharge, 60% of patients were living independently. At follow-up three patients were deceased. Mean angiographic follow-up was 139days (SD 120). There were no aneurysm recurrences among occluded patients and there were no retreatments among those with neck remnants. Coiling of ruptured aneurysms ⩽3mm is feasible with high occlusion rates and low complication rates. The availability of softer coils with flexible detachment zones has led to safe and effective endovascular treatment of tiny ruptured aneurysms.
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, United States. Electronic address: mcanokwu@iupui.edu.
authors.forename: Miracle C
authors.initials: MC
authors.lastname: Anokwute
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, United States; Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States. Electronic address: JBraca@goodmancampbell.com.
authors.forename: John A
authors.initials: JA
authors.lastname: Braca
authors.affiliation: University of Oklahoma, Oklahoma City, OK, United States. Electronic address: Bradley-Bohnstedt@ouhsc.edu.
authors.forename: Bradley
authors.initials: B
authors.lastname: Bohnstedt
authors.affiliation: Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States. Electronic address: ADeNardo@goodmancampbell.com.
authors.forename: Andrew
authors.initials: A
authors.lastname: DeNardo
authors.affiliation: Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States. Electronic address: JScott@goodmancampbell.com.
authors.forename: John
authors.initials: J
authors.lastname: Scott
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, United States; Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States. Electronic address: acohen@goodmancampbell.com.
authors.forename: Aaron
authors.initials: A
authors.lastname: Cohen-Gadol
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, United States; Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States. Electronic address: dsahlein@goodmancampbell.com.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Sahlein
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019233:Retreatment / Q000706:statistics & numerical data; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy*; D013525:Surgical Instruments / Q000009:adverse effects
keywords: 3mm; Endovascular; Subarachnoid hemorrhage; Tiny ruptured aneurysms