Objective: To explore the technique of endovascular therapy for ruptured intracranial very small aneurysms and evaluate the feasibility and safety of endovascular treatment of such aneurysms.
Methods: Twenty-two intracranial very small aneurysms in 22 patients with subarachnoid hemorrhage undergoing endovascular therapy were reviewed retrospectively. Their clinical, imaging, interventional and follow-up data were analyzed. Among them, there were 13 males and 9 females with a mean age of 54.5 years old. The Hunt-Hess grade was as follows: Grades I and II (n = 12) and Grades III and IV (n = 10). The locations of aneurysms were as follows: anterior communicating artery (n = 7), middle cerebral artery (n = 2), posterior communicating artery (n = 8) and internal carotid artery (n = 5). All aneurysms were embolized with coils. Among them, 7 received stent assistance and 2 balloon remodeling.
Results: Among 22 coiled aneurysms, complete occlusion was achieved in 17 aneurysms, neck remnant occurred in 1 patient and aneurysm remnant in 4 patients. Two aneurysms ruptured during coiling and one patient died from it. One patient had transient hemiparesis. All patients received a follow-up of 3 - 36 months and there was no recurrent hemorrhage.
Conclusion: Endovascular treatment of ruptured intracranial very small aneurysms seems to be technically feasible, relatively safe and practically effective. An appropriate selection of interventional materials and use of sophisticated techniques yield an excellent outcome.