Efficacy analysis of endovascular embolization treatment of ruptured intracranial tiny aneurysms

Objective To investigate the methods and efficacy of endovascular embolization treatment of ruptured intracranial tiny aneurysms(maximum diameter ≤3 mm).Methods The data of 45 patients with ruptured intracranial tiny aneurysms(45 aneurysms) were analyzed retrospectively from January 2006 to December 2011.Eleven aneurysms were at the posterior communicating arteries,29 were at the anterior communicating arteries,3 were at the A1 segment of the anterior cerebral arteries,and 2 were at the posterior inferior cerebellar arteries.Twenty-eight patients were embolized with coils only,8 were treated with endovascular stenting and coil embolization,4 were embolized with balloon-assisted technique,3 were embolized with double-microcatheter technique,and 2 were treated with endovascular stenting only.Results ① 28 patients were achieved dense embolization,15 were achieved partial embolization,and 2 had successful stent implantation.② Intraoperative complications: 1 patient experienced intraoperative bleeding.After continuous dense embolization with coils,the patient recovered well postoperatively.One patient had acute thrombosis of the ipsilateral middle cerebral artery during embolization of anterior communicating artery aneurysm,and it was recanalized after thrombosis.However,head CT showed cortex infarction after the procedure,and he was left hemiplegia.External ventricular drainage was performed in 5 patients with ventricular hematocele.③ The modified Rankin scale(mRS) scores at discharge: 0-1 in 28 cases,2 in 14 cases,3-4 in 2 cases,and 5 in 1 case.④ 24 patients were followed up with DSA at 6 to 12 months,and none of them had recurrence.The longest follow-up time in 1 case was 6 years.No recurrence was observed with CT angiography.Conclusion Endovascular embolization is an effective method in the treatment of ruptured intracranial tiny aneurysms.Precise micro-catheter shaping,appropriate coil selection,personalized treatment programs,and reducing complications are the keys to ensuring the efficacy.