Outcome in small aneurysms (<4 mm) treated by endovascular coiling
- Cheemun Lum1,
- Surendra Babu Narayanam1,
- Leonardo Silva1,
- Jai Shankar1,
- Miguel Bussiere2,
- Marlise P Dos Santos1,
- Howard Lesiuk3
- 1Diagnostic Imaging and Interventional Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- 2Department of Medicine-Neurology Division, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- 3Department of Surgery-Division of Neurosurgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
- Correspondence to Dr C Lum, Diagnostic Imaging–Diagnostic and Interventional Neuroradiology, University of Ottawa, 1053 Carling Ave, C1-Diagnostic Imaging, Ottawa, Ontario K1Y 4E9, Canada;
Contributors CL—research, writing and editing of manuscript; SBN, LS, JS—data collection; MB, MPDS, HL—writing and editing of manuscript.
- Received 5 April 2011
- Revised 31 May 2011
- Accepted 1 June 2011
- Published Online First 7 July 2011
Background Coiling of small aneurysms can be technically challenging. These aspects of coiling tend to be less problematic in medium to large aneurysms as they are more accommodating of microcatheters and coils. When physicians are asked their opinion regarding aneurysm coilability in small aneurysms, the decision often lies in the operator's feeling that they could reasonably exclude the aneurysm with a complication rate similar to larger aneurysms. The purpose of our study was to investigate the feasibility, intraprocedural rupture rates and long term durability of endovascular coiling for small (≤4 mm) aneurysms compared with non-small (>4 mm) aneurysms. To control for factors such as vessel tortuosity and aneurysm location, a control group was chosen matched to the study group both in age and aneurysm location.
Materials and methods A retrospective review of 360 intracranial aneurysms coiled at our institution between 2003 and 2008 was performed. For the control group, intracranial aneurysms coiled in the same period matched to location and age were chosen.
Results The frequency of intraprocedural perforations was 4/34 (0.12) and 3/68 (0.04) for the small and non-small cohort, respectively (p=0.22). All patients who had a perforation in the small aneurysm groups had a good clinical outcome compared with 1/3 in the non-small group (two mortalities). The frequency of recanalization for the small and non-small groups was 3/34 (0.09) and 23/68 (0.33), respectively (p=0.006). There was no retreatments in the small aneurysm group and five (0.07) in the non-small group (p=0.116).
Conclusion Coiling of small (≤4 mm) aneurysms is feasible with a reasonable complication rate. There is a non-significant increase in frequency of intraprocedural rupture with coiling of small aneurysms compared with controls matched to aneurysm location and age but this is not associated with increased morbidity. Coiling of small aneurysms leads to durable results at long term follow-up.
Competing interests None.
Ethics approval This study was approved by the Ottawa Hospital Research Ethics Board protocol 2011399-01H.
Provenance and peer review Not commissioned; externally peer reviewed.