Brain Aneurysm Clinical Trial
Official title:
Current Treatment Modalities for Wide Necked Intracranial Aneurysms
- Give an effective treatment for intracranial wide necked aneurysm and can detect the
best method could be used.
- Improve the outcome of these patients and decease rate of recurrence and complications.
The prevalence of intracranial aneurysms in the adult population is estimated to be around 2
%. Most remain asymptomatic, but there is a risk of rupture of 1.2 % per year, and this risk
increases in line with the diameter of the aneurysm. If rupture occurs, subarachnoid
hemorrhage and its associated acute complications are responsible for high mortality (between
30 and 67 %) and morbidity (between 15 and 30 %).
Coil embolization of intracranial aneurysms has made remarkable technological progress since
the International Subarachnoid Aneurysm Trial (ISAT) data were released in 2005. However,
wide-necked aneurysms remain a great challenge to be treated via the endovascular means, as
they are associated with a significantly greater incidence of adverse events when compared
with narrow-necked ones.
Acutely ruptured wide-necked intracranial aneurysms pose technical challenges to the treating
physician; thus, multiple endovascular techniques have been described to treat these lesions,
including balloon-assisted coil placement, double microcatheter technique, and microcatheter
assisted coil placement. However, the use of these techniques can sometimes be limited, owing
to the lack of permanent support for the coil mass inside the aneurysm sac, which may lead to
coil prolapse or migration after the procedure, especially for wide-necked aneurysms
(dome-to-neck ratio is less than 1) or tiny aneurysms (3 mm). Therefore, surgical clipping is
preferred for acutely ruptured wide-necked intracranial aneurysms in most institutions.
Surgery, however, may also be challenging in some of these lesions, since clips may slip, and
surgical access may be limited because of the swelling of the brain in the acute setting of a
subarachnoid hemorrhage.
Flow diverters are new implantable medical devices that make possible to embolize wide-necked
aneurysms without the use of coils; the efficacy results published to date are encouraging in
terms of complete occlusion in the medium-term, thereby confirming the innovative nature of
the flow diversion technique that we aim to evaluate without the use of coils.
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