This Article Full Text Full Text (PDF) All Versions of this Article: 39/3/743    most recent STROKEAHA.107.501007v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Piepgras, D. G. Articles by Brown, R. D. Search for Related Content PubMed PubMed Citation Articles by Piepgras, D. G. Articles by Brown, R. D., Jr Pubmed/NCBI databases Medline Plus Health Information Brain Aneurysm Related Collections Other Stroke Treatment - Surgical Related Article

(Stroke. 2008;39:743.)
© 2008 American Heart Association, Inc.

Editorials

Management of Unruptured Intracranial Aneurysms

Perspectives on Endosaccular Coiling and Persistent Uncertainties

David G. Piepgras, MD Robert D. Brown, Jr, MD, MPH

From the Departments of Neurosurgery and Neurology, Mayo Clinic, Rochester, Minn.

Correspondence to David G. Piepgras, Mayo Clinic, Department of Neurologic Surgery, 200 First Street SW, Rochester, MN 55905, US. E-mail piepgras.david@mayo.edu

Key Words: endovascular treatment • intracranial aneurysm

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 899–904.

In the retrospective analysis of their experience in treating 173 patients with 202 unruptured intracranial aneurysms (UIAs) with endosaccular coiling over a 12 year span from 1992 through August 2004, Standhardt et al¹ document treatment outcomes with low morbidity and mortality but highly variable efficacy relative to durable, complete aneurysm obliteration. Such has been the experience of other investigators.² Although the reported data are of interest, numerous questions remain, including the comprehensive postprocedure assessment of morbidity and mortality, and risk of adverse outcomes compared to natural history.

In this series 48% of the aneurysms were incidentally discovered, and approximately 30% were "other" aneurysms in patients having experienced hemorrhage from another aneurysm, so-called Group II patients in the International Study of Unruptured Intracranial Aneurysms (ISUIA),³ and 14% were symptomatic due to mass effect (typically larger aneurysms). Nearly 44% of these aneurysms were small in size (<7 mm diameter), 37% of medium size (7 to 12 mm) and nearly 20% large to giant in dimension. About half of the aneurysms had a small neck (<4 mm in breadth) which is commonly regarded as optimal for endosaccular coiling assuming no complicating anatomy such as branches arising from the aneurysm base or conditions such as existence of intraluminal thrombus.

Relative to procedural risk, particularly as compared to those of craniotomy and aneurysm clipping, the results which these operators have achieved are excellent—mortality in 0.5% and permanent stroke morbidity in 3.5%, with only 1% ultimately sustaining permanent severe . . . [Full Text of this Article]

Related Article:

Endovascular Treatment of Unruptured Intracranial Aneurysms With Guglielmi Detachable Coils: Short- and Long-Term Results of a Single-Centre Series

Harald Standhardt, Hans Boecher-Schwarz, Andreas Gruber, Thomas Benesch, Engelbert Knosp, and Gerhard Bavinzski
Stroke 2008 39: 899-904. [Abstract] [Full Text] [PDF]