Endovascular Coiling Versus Microsurgical Clipping for Patients With Ruptured Very Small Intracranial Aneurysms: Management Strategies and Clinical Outcomes of 162 Cases.

BACKGROUND: Treatments for intracranial aneurysms mainly include endovascular treatment and craniotomy. Most studies report on large intracranial aneurysms, yet treatments for very small intracranial aneurysms remain controversial. Our purpose was to explore management strategies for ruptured very small intracranial aneurysms.

METHODS: From January 2002 to September 2010, 162 consecutive patients with ruptured very small intracranial aneurysms (≤3 mm) were retrospectively analyzed by comparing procedural data, adverse events, additional procedures, and length of hospital stay between management strategies. Modified Rankin Scale was assessed at 2 months and at 1 year by a postal questionnaire and telephone interview.

RESULTS: Of the 85 patients in the microsurgical group, 79 underwent surgical clipping and 6 underwent wrapping; 77 patients underwent endovascular therapy (endovascular group), including coiling (65 cases), stent-assisted (13 cases) and balloon-assisted (7 cases) coiling, and stenting (2 cases). At 2 months, a good grade (modified Rankin Scale 0-2) was achieved in 74% of patients in the endovascular group and 69.4% of patients in the microsurgical group. At 1 year, a good grade was achieved by 84.9% in the endovascular group and 80% in the microsurgical group. Logistic regression results showed that whichever treatment option was chosen, Hunt-Hess grade, age, cerebral vasospasm, and complications contributed significantly to the prediction of outcome at 2 months.

CONCLUSIONS: Endovascular therapy for ruptured very small intracranial aneurysms was not inferior to surgical clipping and showed a slight trend toward better prognosis.