Endovascular Treatment of Wide-Neck,Ruptured and Unruptured Aneurysms without Supporting Devices

Abstract

Despite of development of various supporting devices in the endovascular treatment (EVT) of wide-neck aneurysms, the procedure remains very challenging. We describe a small series of patients with relatively wide-neck aneurysms treated only by use of 3D coils without supporting devices. In the period July 2011 - August 2012, we treated 23 patients with aneurysm necks > 4 mm or dome/neck ratios < 2. Aneurysms were located in the anterior circulation in 16 patients and in the posterior circulation in seven. The size of aneurysms ranged from three to 21 mm. EVT was achieved by introducing 3D coils of different dimensions in a “Russian doll” fashion. Immediate angiographic results showed complete aneurysm obliteration in 15 patients, small neck remnant in two, and coil protrusion/herniation in four. In one of these cases we had an occlusion of the parent artery and in another case occlusion of the ascending branch (superior cerebellar artery), fortunately both patients remained symptom-free. Clinical results were excellent in 19 patients. One patient developed mild neurologic deficit in the treated territory immediately after the procedure; the patient recovered with mild hemiparesis. One patient developed a delayed stroke in another territory: after treatment the patient left hospital with dysphasia and hemiparesis. The use of 3D coils without neck supporting devices may be a useful alternative in selected cases of wide-neck aneurysms. Larger series with longer follow-up are needed to evaluate the value of this approach.