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Alternative option in the treatment of very small ruptured intracranial aneurysms.

Surgical Neurology 2009 December
BACKGROUND: To evaluate the safety and protective effect of relative undersized coil with loose coil core in the clinical dilemma condition--very small (43.0 mm) ruptured intracranial aneurysm.

METHODS: We studied 12 patients (4 men, 8 women) who had suffered from acute ruptured small intracranial aneurysms (2-3 mm in size, with SAH presentation). All subjects underwent a single coil embolization procedure. An undersized coil (equivalent to the neck size or 0.5 mm smaller than the aneurysm diameter) was chosen as the embolizer. Based on the postembolization angiogram, subjects were divided into 2 groups. One was labeled as the initial complete obliteration group (NR) and the other as the incomplete obliteration group (SR). Fisher exact test and the Wilcoxon rank sum test were used to for statistical analysis.

RESULTS: The technical success rate was 100% without any procedure-related complication. The follow-up interval ranged from 6 to 32 months. No episode of rebleeding or coil migration could be defined in the admissive and following period. Loose coil core were seen in all patients. The total recurrent rate was 8.3% (1/12); only one patient suffered from recurrent lesion in SR group.

CONCLUSION: The preliminary result showed that under-sized coil packing with loose coil core could provide the protective effect and prevent from further rebleeding for very small ruptured aneurysms. It should be considered as an alternative option in the treatment of acute ruptured very small aneurysms when other conventional strategies are not feasible.

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