Purpose In the treatment of superiorly projecting paraclinoid aneurysms (SPP ANs), coil embolization (CE) has been considered inferior to surgical clipping (SC) because of the high rates of recanalization and ischemic complication. However, innovation of endovascular technology could overcome such disadvantages. This study was designed to evaluate recent results of CE in SPP ANs.

Materials and Methods 43 consecutive patients with unruptured SPP ANs treated between 2004 and 2010 were retrospectively reviewed. SPP ANs include ophthalmic ANs and anterior wall ANs (AW ANs). Ophthalmic ANs arise at the junction of the ophthalmic artery and the internal carotid artery (ICA). AW ANs superiorly arise from the supraclinoid ICA without branching arteries. Midterm angiographic outcomes and complication rate were compared between CE and SC.

Results 33 patients underwent CE and 10 patients underwent SC. The CE group included 30 small ANs (<12 mm) and three large ANs (12–25 mm). The SC group included eight small ANs and two large ANs. In the CE group, recanalization was observed in two large ANs (6.1%) for a mean follow-up period of 27.2 months. Small ANs did not reveal recanalization. One of the recanalised ANs underwent a second CE and no recanalization was observed for 12 months after retreatment. The other received parent artery occlusion. In the SC group, no recanalization was observed during the follow-up period (mean: 32.9 months). Procedure-related morbidity was 2.9% (1/33) in the CE group and 10.0% (1/10) in the SC group.

Conclusion Coil embolization for SPP ANs was equivalent to SC in terms of midterm durability and safety, particularly for small ANs.

Competing interests None.