Stent-assisted coiling in endovascular embolization of unruptured very small intracranial aneurysms

Objective To evaluate the indication, safety and clinical effect of stent-assisted embolization in the treatment of unruptured very small intracranial aneurysms. Methods From January 2013 to September 2016, the clinical data of 25 patients with 25 unruptured very small intracranial aneurysms were retrospectively analyzed who underwent stent-assisted embolization at Department of Interventional Neurology, People's Hospital of Zhengzhou University. The indication and safety were summarized. The mean follow-up period was 9 months (range: 3-24 months) and the clinical effects were evaluated based on modified Rankin Scale (mRS) and self-rating anxiety scale (SAS). Results The reasons why endovascular treatment was performed for the very small aneurysms in this group included sentinel headache, multiple aneurysms, irregular aneurysmal shape, enlargement of aneurysms in follow-up period and severe anxiety. The success rate of the operations of the 25 very small aneurysms was 100%. Immediate Raymond Ⅰ grade was observed in 88% (n=22), Ⅱ grade in 8% (n=2) and Ⅲ grade in 4% (n=1). No aneurysm rupture or thrombus formation was found during the procedures. The Raymond Ⅰ grade was up to 94% in 18 cases who were angiographically followed up. During the follow-up period, no bleeding occurred and the mRS score was 0 for all 25 patients. Out of the 5 patients receiving SAS evaluation, 4 were normal and 1 had mild anxiety. Conclusions Endovascular embolization seems to be safe and effective for proper candidates with unruptured very small aneurysms. The application of stent could significantly expand the indications and improve the rate of complete embolization. Key words: Intracranial aneurysm; Stents; Embolization, therapeutic; Treatment outcome; Small aneurysms