A Multicenter Study of Stent-Assisted Coiling of Cerebral Aneurysms With a Y Configuration

Patient selection for endovascular treatment of intracranial aneurysms

With recent advancement in medical imaging, techniques, and endovascular tools more patients are diagnosed with unruptured intracranial aneurysms. The main aim of offering aneurysm treatment is to ameliorate the risk of future aneurysm bleeding, while not posing additional risks on the patient from the treatment itself. We discuss in this paper our approach of selecting patients for treatment (simple coiling, balloon-assisted, stent-assisted, vessel sacrifice, or flow-divertion stents). Our decision-making is based on the published data and our center experience. Risks of all option are compared to each other and weighed against natural history of intracranial aneurysms. In this paper, literature is cited and case illustrations are presented to support this approach. Factors that affect our decision-making are aneurysm location, presentation, size, aneurysm geometry, parent vessel anatomy, and relevant co-morbidities.

Endovascular management of recurrent aneurysms

As neuroendovascular interventions for both ruptured and unruptured intracranial aneurysms have come to the forefront, careful follow-up and strategies for retreatment of aneurysmal recurrences have become increasingly important. Endovascular approaches have also proven to be valuable adjuncts for managing recurrent aneurysms previously treated by open microsurgical approaches. Fortunately, retreatment of recurrent aneurysms can be performed safely, and the use of stents during retreatment has increased the proportion of durably retreated aneurysms. More recently, the spectrum of recurrent aneurysms readily amenable to endovascular therapy has been expanded by the widespread introduction of flow diverters.

Endovascular treatment of posterior circulation aneurysms

Endovascular techniques are well suited for the treatment of posterior circulation aneurysms. This review describes the endovascular management of these aneurysms and discusses relevant technical advances.