Endovascular Treatment of Intracranial Unruptured Aneurysms: Systematic Review and Meta-Analysis of the Literature on Safety and Efficacy

Published Online:https://doi.org/10.1148/radiol.10091982

Results of this review cannot be used to justify endovascular treatment of unruptured aneurysms (UAs) but are a motivation to perform a well-conducted randomized controlled trial to obtain scientific proof of the potential benefit of treatment of UAs.

Purpose

To report an updated, systematic review of medical literature from January 2003 to July 2008, on endovascular treatment (EVT) of intracranial unruptured aneurysms (UAs) (a) to assess the morbidity and case fatality rate of EVT of UAs, (b) to understand how bias can affect results, and (c) to estimate the efficacy of EVT by using reported digital subtraction angiographic (DSA) results and clinical follow-up events.

Materials and Methods

This article was prepared in accordance with the Meta-Analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature was searched by using PubMed and the EMBASE and Cochrane Library databases. Eligibility criteria were (a) explicit procedural mortality and morbidity rates; (b) at least 10 patients; (c) saccular, intradural, nondissecting UAs; (d) original study published in English or French between January 2003 and July 2008; and (e) a methodological quality score higher than 6, according to Strengthening the Reporting of Observational Studies in Epidemiology criteria. End points included procedural mortality and morbidity, defined as a modified Rankin scale score of 3–6 at 1 month, and efficacy, estimated by using immediate and follow-up digital subtraction angiographic results, as well as delayed hemorrhagic events.

Results

Seventy-one studies were included. Procedural unfavorable outcome was found in 4.8% (random-effect weighted average; 189 of 5044) of patients (99% confidence interval [CI]: 3.9%, 6.0%). Immediate angiographic results showed satisfactory occlusion in 86.1% (2660 of 3089) of UAs. Recurrences were shown in 321 (24.4%) of 1316 patients followed up for 0.4–3.2 years. Retreatment was performed in 9.1% (random-effect weighted average; 166 of 1699) of patients (99% CI: 6.2%, 13.1%). The annual risk of bleeding after EVT was 0.2% (random-effect weighted average; nine of 1395) of patients (99% CI: 0.1%, 0.3%), but clinical follow-up was short, limited to the first 6 months for 76.7% (n = 1071) of reported patients.

Conclusion

EVT of UAs can be performed with relative safety. The efficacy of treatment as compared with observation has not been rigorously documented.

© RSNA, 2010

Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10091982/-/DC1

References

  • 1 Rinkel GJ , Djibuti M , Algra A , van Gijn J . Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 1998;29(1):251–256. Crossref, MedlineGoogle Scholar
  • 2 Burns JD , Brown RD . Treatment of unruptured intracranial aneurysms: surgery, coiling, or nothing? Curr Neurol Neurosci Rep 2009;9(1):6–12. Crossref, MedlineGoogle Scholar
  • 3 White PM , Wardlaw JM . Unruptured intracranial aneurysms. J Neuroradiol 2003;30(5):336–350. MedlineGoogle Scholar
  • 4 Cowan JA , Ziewacz J , Dimick JB , Upchurch GR , Thompson BG . Use of endovascular coil embolization and surgical clip occlusion for cerebral artery aneurysms. J Neurosurg 2007;107(3):530–535. Crossref, MedlineGoogle Scholar
  • 5 Raymond J , Guilbert F , Weill A , Roy D . Unruptured intracranial aneurysms: a call for a randomized clinical trial. AJNR Am J Neuroradiol 2006;27(2):242–243. MedlineGoogle Scholar
  • 6 Raymond J . Incidental intracranial aneurysms: rationale for treatment. Curr Opin Neurol 2009;22(1):96–102. Crossref, MedlineGoogle Scholar
  • 7 Lanterna LA , Tredici G , Dimitrov BD , Biroli F . Treatment of unruptured cerebral aneurysms by embolization with guglielmi detachable coils: case-fatality, morbidity, and effectiveness in preventing bleeding–a systematic review of the literature. Neurosurgery 2004;55(4):767–775; discussion 775–778. Crossref, MedlineGoogle Scholar
  • 8 Stroup DF , Berlin JA , Morton SC , et al. . Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283(15):2008–2012. Crossref, MedlineGoogle Scholar
  • 9 Moher D , Liberati A , Tetzlaff J , Altman DG ; PRISMA Group . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151(4):264–269, W64. Crossref, MedlineGoogle Scholar
  • 10 von Elm E , Altman DG , Egger M , Pocock SJ , Gøtzsche PC , Vandenbroucke JP ; STROBE Initiative . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007;370(9596):1453–1457. Crossref, MedlineGoogle Scholar
  • 11 Kasner SE . Clinical interpretation and use of stroke scales. Lancet Neurol 2006;5(7):603–612. Crossref, MedlineGoogle Scholar
  • 12 Higgins JP , Thompson SG . Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21(11):1539–1558. Crossref, MedlineGoogle Scholar
  • 13 Higgins JP , Thompson SG , Deeks JJ , Altman DG . Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557–560. Crossref, MedlineGoogle Scholar
  • 14 Higgins JPGreen S, eds. Cochrane handbook for systematic reviews of interventions, version 5.0.1. The Cochrane Collaboration 2008. http://www.cochrane-handbook.org. Published September 2006. Accessed August 2008. Google Scholar
  • 15 Egger M , Davey Smith G , Schneider M , Minder C . Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315(7109):629–634. Crossref, MedlineGoogle Scholar
  • 16 Souza JP , Pileggi C , Cecatti JG . Assessment of funnel plot asymmetry and publication bias in reproductive health meta-analyses: an analytic survey. Reprod Health 2007;4:3. doi:10.1186/1742-4755-4-3. Accessed May 2010. Crossref, MedlineGoogle Scholar
  • 17 Sterne JA , Egger M . Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 2001;54(10):1046–1055. Crossref, MedlineGoogle Scholar
  • 18 Macaskill P , Walter SD , Irwig L . A comparison of methods to detect publication bias in meta-analysis. Stat Med 2001;20(4):641–654. Crossref, MedlineGoogle Scholar
  • 19 Papathanasiou AA , Zintzaras E . Assessing the quality of reporting of observational studies in cancer. Ann Epidemiol 2010;20(1):67–73. Crossref, MedlineGoogle Scholar
  • 20 Molyneux AJ , Cekirge S , Saatci I , Gál G . Cerebral Aneurysm Multicenter European Onyx (CAMEO) trial: results of a prospective observational study in 20 European centers. AJNR Am J Neuroradiol 2004;25(1):39–51. MedlineGoogle Scholar
  • 21 White PM , Lewis SC , Nahser H , Sellar RJ , Goddard T , Gholkar A ; HELPS Trial Collaboration. HydroCoil Endovascular Aneurysm Occlusion and Packing Study (HELPS trial): procedural safety and operator-assessed efficacy results. AJNR Am J Neuroradiol 2008;29(2):217–223. Crossref, MedlineGoogle Scholar
  • 22 Higashida RT , Lahue BJ , Torbey MT , Hopkins LN , Leip E , Hanley DF . Treatment of unruptured intracranial aneurysms: a nationwide assessment of effectiveness. AJNR Am J Neuroradiol 2007;28(1):146–151. MedlineGoogle Scholar
  • 23 Royston P , Altman DG , Sauerbrei W . Dichotomizing continuous predictors in multiple regression: a bad idea. Stat Med 2006;25(1):127–141. Crossref, MedlineGoogle Scholar
  • 24 Wermer MJ , van der Schaaf IC , Algra A , Rinkel GJ . Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: an updated meta-analysis. Stroke 2007;38(4):1404–1410. Crossref, MedlineGoogle Scholar
  • 25 Egger M , Zellweger-Zähner T , Schneider M , Junker C , Lengeler C , Antes G . Language bias in randomised controlled trials published in English and German. Lancet 1997;350(9074):326–329. Crossref, MedlineGoogle Scholar
  • 26 Jüni P , Holenstein F , Sterne J , Bartlett C , Egger M . Direction and impact of language bias in meta-analyses of controlled trials: empirical study. Int J Epidemiol 2002;31(1):115–123. Crossref, MedlineGoogle Scholar
  • 27 Greving JP , Rinkel GJ , Buskens E , Algra A . Cost-effectiveness of preventive treatment of intracranial aneurysms: new data and uncertainties. Neurology 2009;73(4):258–265. Crossref, MedlineGoogle Scholar
  • 28 Chang HS . Simulation of the natural history of cerebral aneurysms based on data from the International Study of Unruptured Intracranial Aneurysms. J Neurosurg 2006;104(2):188–194. Crossref, MedlineGoogle Scholar
  • 29 Raymond J , Molyneux AJ , Fox AJ , et al. . The TEAM trial: safety and efficacy of endovascular treatment of unruptured intracranial aneurysms in the prevention of aneurysmal hemorrhages: a randomized comparison with indefinite deferral of treatment in 2002 patients followed for 10 years. Trials 2008;9:43. http://www.trialsjournal.com/content/9/1/43. Published July 16, 2008. Accessed May 2010. Crossref, MedlineGoogle Scholar
  • 30 Findlay JM . Managing unruptured intracranial aneurysms. Can J Neurol Sci 2009;36(1):4–5. Crossref, MedlineGoogle Scholar
  • 31 Raymond J . Managing unruptured aneurysms: the ethical solution to the dilemma. Can J Neurol Sci 2009;36(2):138–142. Crossref, MedlineGoogle Scholar
  • 32 Wiebers DO , Whisnant JP , Huston J , et al. . Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362(9378):103–110. Crossref, MedlineGoogle Scholar
  • 33 Weber W , Siekmann R , Kis B , Kuehne D . Treatment and follow-up of 22 unruptured wide-necked intracranial aneurysms of the internal carotid artery with Onyx HD 500. AJNR Am J Neuroradiol 2005;26(8):1909–1915. MedlineGoogle Scholar
  • 34 Gallas S , Drouineau J , Gabrillargues J , et al. . Feasibility, procedural morbidity and mortality, and long-term follow-up of endovascular treatment of 321 unruptured aneurysms. AJNR Am J Neuroradiol 2008;29(1):63–68. Crossref, MedlineGoogle Scholar
  • 35 Pierot L , Spelle L , Vitry F ; ATENA Investigators. Immediate clinical outcome of patients harboring unruptured intracranial aneurysms treated by endovascular approach: results of the ATENA study. Stroke 2008;39(9):2497–2504. Crossref, MedlineGoogle Scholar
  • 36 Brilstra EH , Rinkel GJ , van der Graaf Y , et al. . Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolisation with coils: a prospective, observational study. Cerebrovasc Dis 2004;17(1):44–52. Crossref, MedlineGoogle Scholar
  • 37 Vallée JN , Pierot L , Mont’alverne F , et al. . Unruptured intracranial aneurysms treated by three-dimensional coil embolization: evaluation of the postoperative aneurysm occlusion volume. Neuroradiology 2005;47(6):438–445. Crossref, MedlineGoogle Scholar
  • 38 Kwon OK , Kim SH , Kwon BJ , et al. . Endovascular treatment of wide-necked aneurysms by using two microcatheters: techniques and outcomes in 25 patients. AJNR Am J Neuroradiol 2005;26(4):894–900. MedlineGoogle Scholar
  • 39 Tsukahara T , Murakami N , Sakurai Y , et al. . Treatment of unruptured cerebral aneurysms; a multi-center study at Japanese national hospitals. Acta Neurochir Suppl 2005;94:77–85. Crossref, MedlineGoogle Scholar
  • 40 Kim BM , Kim DI , Chung EC , et al. . Endovascular coil embolization for anterior choroidal artery aneurysms. Neuroradiology 2008;50(3):251–257. Crossref, MedlineGoogle Scholar
  • 41 Kim BM , Kim DI , Shin YS , et al. . Clinical outcome and ischemic complication after treatment of anterior choroidal artery aneurysm: comparison between surgical clipping and endovascular coiling. AJNR Am J Neuroradiol 2008;29(2):286–290. Crossref, MedlineGoogle Scholar
  • 42 Park HK , Horowitz M , Jungreis C , et al. . Endovascular treatment of paraclinoid aneurysms: experience with 73 patients. Neurosurgery 2003;53(1):14–23; discussion 24. Crossref, MedlineGoogle Scholar
  • 43 Raftopoulos C , Goffette P , Vaz G , et al. . Surgical clipping may lead to better results than coil embolization: results from a series of 101 consecutive unruptured intracranial aneurysms. Neurosurgery 2003;52(6):1280–1287; discussion 1287–1290. Crossref, MedlineGoogle Scholar
  • 44 Soeda A , Sakai N , Sakai H , et al. . Thromboembolic events associated with Guglielmi detachable coil embolization of asymptomatic cerebral aneurysms: evaluation of 66 consecutive cases with use of diffusion-weighted MR imaging. AJNR Am J Neuroradiol 2003;24(1):127–132. MedlineGoogle Scholar
  • 45 Groden C , Eckert B , Ries T , Probst EN , Kucinski T , Zeumer H . Angiographic follow-up of vertebrobasilar artery aneurysms treated with detachable coils. Neuroradiology 2003;45(7):435–440. Crossref, MedlineGoogle Scholar
  • 46 Murayama Y , Nien YL , Duckwiler G , et al. . Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 2003;98(5):959–966. Crossref, MedlineGoogle Scholar
  • 47 Vallee JN , Aymard A , Vicaut E , Reis M , Merland JJ . Endovascular treatment of basilar tip aneurysms with Guglielmi detachable coils: predictors of immediate and long-term results with multivariate analysis 6-year experience. Radiology 2003;226(3):867–879. LinkGoogle Scholar
  • 48 Benitez RP , Silva MT , Klem J , Veznedaroglu E , Rosenwasser RH . Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery 2004;54(6):1359–1367; discussion 1368. Crossref, MedlineGoogle Scholar
  • 49 Yu SC , Chan MS , Boet R , Wong JK , Lam JM , Poon WS . Intracranial aneurysms treated with Guglielmi detachable coils: midterm clinical and radiological outcome in 97 consecutive Chinese patients in Hong Kong. AJNR Am J Neuroradiol 2004;25(2):307–313. MedlineGoogle Scholar
  • 50 Niemann D , Aviv R , Cowsill C , Sneade M , Molyneux AJ . Anatomically conformable, three-dimensional, detachable platinum microcoil system for the treatment of intracranial aneurysms. AJNR Am J Neuroradiol 2004;25(5):813–818. MedlineGoogle Scholar
  • 51 Gonzalez N , Murayama Y , Nien YL , et al. . Treatment of unruptured aneurysms with GDCs: clinical experience with 247 aneurysms. AJNR Am J Neuroradiol 2004;25(4):577–583. MedlineGoogle Scholar
  • 52 Soeda A , Sakai N , Sakai H , Iihara K , Nagata I . Endovascular treatment of asymptomatic cerebral aneurysms: anatomic and technical factors related to ischemic events and coil stabilization. Neurol Med Chir (Tokyo) 2004;44(9):456–465; discussion 466. Crossref, MedlineGoogle Scholar
  • 53 Henkes H , Fischer S , Mariushi W , et al. . Angiographic and clinical results in 316 coil-treated basilar artery bifurcation aneurysms. J Neurosurg 2005;103(6):990–999. Crossref, MedlineGoogle Scholar
  • 54 Ross IB , Dhillon GS . Complications of endovascular treatment of cerebral aneurysms. Surg Neurol 2005;64(1):12–18; discussion 18–19. Crossref, MedlineGoogle Scholar
  • 55 Arthur AS , Wilson SA , Dixit S , Barr JD . Hydrogel-coated coils for the treatment of cerebral aneurysms: preliminary results. Neurosurg Focus 2005;18(2):E1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15715446. Published February 2005. Accessed August 22, 2008. Crossref, MedlineGoogle Scholar
  • 56 Katz JM , Tsiouris AJ , Biondi A , et al. . Advances in endovascular aneurysm treatment: are we making a difference? Neuroradiology 2005;47(9):695–701. Crossref, MedlineGoogle Scholar
  • 57 Akpek S , Arat A , Morsi H , Klucznick RP , Strother CM , Mawad ME . Self-expandable stent-assisted coiling of wide-necked intracranial aneurysms: a single-center experience. AJNR Am J Neuroradiol 2005;26(5):1223–1231. MedlineGoogle Scholar
  • 58 Mordasini P , Schroth G , Guzman R , Barth A , Seiler RW , Remonda L . Endovascular treatment of posterior circulation cerebral aneurysms by using Guglielmi detachable coils: a 10-year single-center experience with special regard to technical development. AJNR Am J Neuroradiol 2005;26(7):1732–1738. MedlineGoogle Scholar
  • 59 Terada T , Tsuura M , Matsumoto H , et al. . Endovascular treatment of unruptured cerebral aneurysms. Acta Neurochir Suppl 2005;94:87–91. Crossref, MedlineGoogle Scholar
  • 60 Lubicz B , Piotin M , Mounayer C , Spelle L , Moret J . Selective endovascular treatment of intracranial aneurysms with a liquid embolic: a single-center experience in 39 patients with 41 aneurysms. AJNR Am J Neuroradiol 2005;26(4):885–893. MedlineGoogle Scholar
  • 61 Park HK , Horowitz M , Jungreis C , et al. . Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 2005;26(3):506–514. MedlineGoogle Scholar
  • 62 Iijima A , Piotin M , Mounayer C , Spelle L , Weill A , Moret J . Endovascular treatment with coils of 149 middle cerebral artery berry aneurysms. Radiology 2005;237(2):611–619. LinkGoogle Scholar
  • 63 van Rooij WJ , Sluzewski M . Procedural morbidity and mortality of elective coil treatment of unruptured intracranial aneurysms. AJNR Am J Neuroradiol 2006;27(8):1678–1680. MedlineGoogle Scholar
  • 64 Pouratian N , Oskouian RJ , Jensen ME , Kassell NF , Dumont AS . Endovascular management of unruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry 2006;77(5):572–578. Crossref, MedlineGoogle Scholar
  • 65 Taha MM , Nakahara I , Higashi T , et al. . Endovascular embolization vs surgical clipping in treatment of cerebral aneurysms: morbidity and mortality with short-term outcome. Surg Neurol 2006;66(3):277–284; discussion 284. Crossref, MedlineGoogle Scholar
  • 66 Ries T , Buhk JH , Kucinski T , et al. . Intravenous administration of acetylsalicylic acid during endovascular treatment of cerebral aneurysms reduces the rate of thromboembolic events. Stroke 2006;37(7):1816–1821. Crossref, MedlineGoogle Scholar
  • 67 Gaba RC , Ansari SA , Roy SS , Marden FA , Viana MA , Malisch TW . Embolization of intracranial aneurysms with hydrogel-coated coils versus inert platinum coils: effects on packing density, coil length and quantity, procedure performance, cost, length of hospital stay, and durability of therapy. Stroke 2006;37(6):1443–1450. Crossref, MedlineGoogle Scholar
  • 68 Lubicz B , Leclerc X , Levivier M , et al. . Retractable self-expandable stent for endovascular treatment of wide-necked intracranial aneurysms: preliminary experience. Neurosurgery 2006;58(3):451–457; discussion 451–457. Crossref, MedlineGoogle Scholar
  • 69 Grunwald IQ , Papanagiotou P , Politi M , Struffert T , Roth C , Reith W . Endovascular treatment of unruptured intracranial aneurysms: occurrence of thromboembolic events. Neurosurgery 2006;58(4):612–618; discussion 612–618. Crossref, MedlineGoogle Scholar
  • 70 Kis B , Weber W , Berlit P , Kühne D . Elective treatment of saccular and broad-necked intracranial aneurysms using a closed-cell nitinol stent (Leo). Neurosurgery 2006;58(3):443–450; discussion 443–450. Crossref, MedlineGoogle Scholar
  • 71 Cekirge HS , Saatci I , Ozturk MH , et al. . Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single-center experience. Neuroradiology 2006;48(2):113–126. Crossref, MedlineGoogle Scholar
  • 72 Cekirge HS , Saatci I , Geyik S , Yavuz K , Oztürk H , Pamuk G . Intrasaccular combination of metallic coils and onyx liquid embolic agent for the endovascular treatment of cerebral aneurysms. J Neurosurg 2006;105(5):706–712. Crossref, MedlineGoogle Scholar
  • 73 Solheim O , Eloqayli H , Muller TB , Unsgaard G . Quality of life after treatment for incidental, unruptured intracranial aneurysms. Acta Neurochir (Wien) 2006;148(8):821–830; discussion 830. Crossref, MedlineGoogle Scholar
  • 74 Katsaridis V , Papagiannaki C , Violaris C . Embolization of acutely ruptured and unruptured wide-necked cerebral aneurysms using the neuroform2 stent without pretreatment with antiplatelets: a single center experience. AJNR Am J Neuroradiol 2006;27(5):1123–1128. MedlineGoogle Scholar
  • 75 Katsaridis V , Papagiannaki C , Violaris C . Guglielmi detachable coils versus matrix coils: a comparison of the immediate posttreatment results of the embolization of 364 cerebral aneurysms in 307 patients: a single-center, single-surgeon experience. AJNR Am J Neuroradiol 2006;27(9):1841–1848. MedlineGoogle Scholar
  • 76 Doerfler A , Wanke I , Goericke SL , et al. . Endovascular treatment of middle cerebral artery aneurysms with electrolytically detachable coils. AJNR Am J Neuroradiol 2006;27(3):513–520. MedlineGoogle Scholar
  • 77 van Rooij WJ , Sluzewski M , Beute GN . Endovascular treatment of posterior cerebral artery aneurysms. AJNR Am J Neuroradiol 2006;27(2):300–305. MedlineGoogle Scholar
  • 78 van Rooij WJ , de Gast A , Sluzewski M , Nijssen PC , Beute GN . Coiling of truly incidental intracranial aneurysms. AJNR Am J Neuroradiol 2006;27(2):293–296. MedlineGoogle Scholar
  • 79 Szikora I , Berentei Z , Kulcsar Z , et al. . Endovascular treatment of intracranial aneurysms with parent vessel reconstruction using balloon and self expandable stents. Acta Neurochir (Wien) 2006;148(7):711–723; discussion 723. Crossref, MedlineGoogle Scholar
  • 80 Bradac GB , Bergui M , Stura G , et al. . Periprocedural morbidity and mortality by endovascular treatment of cerebral aneurysms with GDC: a retrospective 12-year experience of a single center. Neurosurg Rev 2007;30(2):117–125; discussion 125–126. Crossref, MedlineGoogle Scholar
  • 81 Gerlach R , Beck J , Setzer M , et al. . Treatment related morbidity of unruptured intracranial aneurysms: results of a prospective single centre series with an interdisciplinary approach over a 6 year period (1999-2005). J Neurol Neurosurg Psychiatry 2007;78(8):864–871. Crossref, MedlineGoogle Scholar
  • 82 van Rooij WJ , Sluzewski M . Coiling of very large and giant basilar tip aneurysms: midterm clinical and angiographic results. AJNR Am J Neuroradiol 2007;28(7):1405–1408. Crossref, MedlineGoogle Scholar
  • 83 Biondi A , Janardhan V , Katz JM , Salvaggio K , Riina HA , Gobin YP . Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery 2007;61(3):460–468; discussion 468–469. Crossref, MedlineGoogle Scholar
  • 84 Taschner CA , Leclerc X , Gauvrit JY , et al. . Safety of endovascular treatment of intracranial aneurysms with a new, complex shaped Guglielmi detachable coil. Neuroradiology 2007;49(9):761–766. Crossref, MedlineGoogle Scholar
  • 85 Grunwald IQ , Papanagiotou P , Struffert T , et al. . Recanalization after endovascular treatment of intracerebral aneurysms. Neuroradiology 2007;49(1):41–47. Crossref, MedlineGoogle Scholar
  • 86 Fanning NF , Berentei Z , Brennan PR , Thornton J . HydroCoil as an adjuvant to bare platinum coil treatment of 100 cerebral aneurysms. Neuroradiology 2007;49(2):139–148. Crossref, MedlineGoogle Scholar
  • 87 Geyik S , Yavuz K , Cekirge S , Saatci I . Endovascular treatment of basilar and ICA termination aneurysms: effects of the use of HydroCoils on treatment stability in a subgroup of patients prone to a higher recurrence rate. Neuroradiology 2007;49(12):1015–1021. Crossref, MedlineGoogle Scholar
  • 88 Deshaies EM , Adamo MA , Boulos AS . A prospective single-center analysis of the safety and efficacy of the hydrocoil embolization system for the treatment of intracranial aneurysms. J Neurosurg 2007;106(2):226–233. Crossref, MedlineGoogle Scholar
  • 89 Lubicz B , Levivier M , Sadeghi N , Emonts P , Balériaux D . Immediate intracranial aneurysm occlusion after embolization with detachable coils: a comparison between MR angiography and intra-arterial digital subtraction angiography. J Neuroradiol 2007;34(3):190–197. Crossref, MedlineGoogle Scholar
  • 90 Lubicz B , Balériaux D , Lefranc F , Brotchi J , Bruneau M , Levivier M . Endovascular treatment of intracranial aneurysms as the first thérapeutic option. J Neuroradiol 2007;34(4):250–259. Crossref, MedlineGoogle Scholar
  • 91 Souza JR , Otoch M , Ribeiro SP , et al. . Endovascular treatment of cerebral aneurysms: a retrospective study of 163 embolized aneurysms. Arq Neuropsiquiatr 2007;65(2B):411–415. Crossref, MedlineGoogle Scholar
  • 92 Quadros RS , Gallas S , Noudel R , Rousseaux P , Pierot L . Endovascular treatment of middle cerebral artery aneurysms as first option: a single center experience of 92 aneurysms. AJNR Am J Neuroradiol 2007;28(8):1567–1572. Crossref, MedlineGoogle Scholar
  • 93 Rossitti S . Endovascular coiling of intracranial aneurysms using bioactive coils: a single-center study. Acta Radiol 2007;48(5):565–576. Crossref, MedlineGoogle Scholar
  • 94 Standhardt H , Boecher-Schwarz H , Gruber A , Benesch T , Knosp E , Bavinzski G . Endovascular treatment of unruptured intracranial aneurysms with Guglielmi detachable coils: short- and long-term results of a single-centre series. Stroke 2008;39(3):899–904. Crossref, MedlineGoogle Scholar
  • 95 Peluso JP , van Rooij WJ , Sluzewski M , Beute GN , Majoie CB . Posterior inferior cerebellar artery aneurysms: incidence, clinical presentation, and outcome of endovascular treatment. AJNR Am J Neuroradiol 2008;29(1):86–90. Crossref, MedlineGoogle Scholar
  • 96 Peluso JP , van Rooij WJ , Sluzewski M , Beute GN . Coiling of basilar tip aneurysms: results in 154 consecutive patients with emphasis on recurrent haemorrhage and re-treatment during mid- and long-term follow-up. J Neurol Neurosurg Psychiatry 2008;79(6):706–711. Crossref, MedlineGoogle Scholar
  • 97 Yahia AM , Gordon V , Whapham J , Malek A , Steel J , Fessler RD . Complications of Neuroform stent in endovascular treatment of intracranial aneurysms. Neurocrit Care 2008;8(1):19–30. Crossref, MedlineGoogle Scholar

Article History

Received November 2, 2009; revision requested January 4, 2010; final revision received February 9; accepted February 12; final version accepted March 1.
Published online: Sept 2010
Published in print: Sept 2010