CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2018; 07(03): 209-215
DOI: 10.1055/s-0038-1669478
Review Article
Neurological Surgeons' Society of India

Endovascular Management of Cerebral Aneurysm: The Recent Trends

Vipul Gupta
1   Department of Interventional Neuroradiology, Artemis Agrim Institute of Neurosciences, Gurgaon, Haryana, India
Shrikant Londhe
1   Department of Interventional Neuroradiology, Artemis Agrim Institute of Neurosciences, Gurgaon, Haryana, India
Rajsrinivas Parthasarathy
1   Department of Interventional Neuroradiology, Artemis Agrim Institute of Neurosciences, Gurgaon, Haryana, India
Hilal Ahmad Ganaie
1   Department of Interventional Neuroradiology, Artemis Agrim Institute of Neurosciences, Gurgaon, Haryana, India
› Author Affiliations
Further Information

Publication History

Received: 28 May 2018

accepted: 09 July 2018

Publication Date:
31 August 2018 (online)


Cerebral aneurysm rupture is the leading cause of mortality and morbidity in patients with hemorrhagic stroke. Surgical clipping and endovascular coiling are the mainstay of management for securing the aneurysm. After International Subarachnoid Aneurysm Trial (ISAT) and Barrow Ruptured Aneurysm Trial (BRAT) results, worldwide trend has shifted gradually in favor of endovascular management. Nonetheless, endovascular management was faced with some limitations, especially while treating giant, wide neck bifurcation, blister, and small uncoilable aneurysm. The recent introduction of new devices such as flow diverter stents, microstents, bifurcation devices, double-lumen balloon catheters, and microcoils have proved to be effective in overcoming the limitations of traditional aneurysm coiling. The authors present a review of recent advances in the endovascular management of cerebral aneurysm.

  • References

  • 1 Guglielmi G. History of endovascular endosaccular occlusion of brain aneurysms: 1965-1990. Interv Neuroradiol 2007; 13 (03) 217-224
  • 2 Serbinenko FA. Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 1974; 41 (02) 125-145
  • 3 Guglielmi G, Viñuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg 1991; 75 (01) 8-14
  • 4 Moret J, Cognard C, Weill A, Castaings L, Rey A. The “remodelling technique” in the treatment of wide neck intracranial aneurysms. angiographic results and clinical follow-up in 56 cases. Interv Neuroradiol 1997; 3 (01) 21-35
  • 5 Henkes H, Bose A, Felber S, Miloslavski E, Berg-Dammer E, Kühne D. Endovascular coil occlusion of intracranial aneurysms assisted by a novel self-expandable nitinol microstent (neuroform). Interv Neuroradiol 2002; 8 (02) 107-119
  • 6 Molyneux AJ, Kerr RSC, Yu LM. et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005; 366 9488 809-817
  • 7 Goel G, Gupta V, Chinchure S, Gupta A, Kaur G, Jha AN. A decade after International Subarachnoid Aneurysm Trial: coiling as a first choice treatment in the management of intracranial aneurysms—technical feasibility and early management outcomes. Asian J Neurosurg 2014; 9 (03) 137-143
  • 8 Molyneux AJ, Birks J, Clarke A, Sneade M, Kerr RSC. The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet 2015; 385 9969 691-697
  • 9 Fiorella D, Lylyk P, Szikora I. et al. Curative cerebrovascular reconstruction with the pipeline embolization device: the emergence of definitive endovascular therapy for intracranial aneurysms. J Neurointerv Surg 2009; 1 (01) 56-65
  • 10 Becske T, Brinjikji W, Potts MB. et al. Long-term clinical and angiographic outcomes following pipeline embolization device treatment of complex internal carotid artery aneurysms: five-year results of the Pipeline for Uncoilable or Failed Aneurysms Trial. Neurosurgery 2017; 80 (01) 40-48
  • 11 Nelson PK, Lylyk P, Szikora I, Wetzel SG, Wanke I, Fiorella D. The pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR Am J Neuroradiol 2011; 32 (01) 34-40
  • 12 Rajah G, Narayanan S, Rangel-Castilla L. Update on flow diverters for the endovascular management of cerebral aneurysms. Neurosurg Focus 2017; 42 (06) E2
  • 13 Gupta V, Parthasarathy R, Jha AN. Endovascular reconstruction of aneurysms with a complex geometry. Neurol India 2016; 64 (07) Suppl S24-S31
  • 14 Rouchaud A, Brinjikji W, Cloft HJ, Kallmes DF. Endovascular treatment of ruptured blister-like aneurysms: a systematic review and meta-analysis with focus on deconstructive versus reconstructive and flow-diverter treatments. AJNR Am J Neuroradiol 2015; 36 (12) 2331-2339
  • 15 Mokin M, Chinea A, Primiani CT. et al. Treatment of blood blister aneurysms of the internal carotid artery with flow diversion. J Neurointerventional Surg. 2018 doi: 10.1136/neurintsurg-2017-013701 [Epub ahead of print]
  • 16 Chinchure SD, Gupta V, Goel G, Gupta A, Jha A. Subarachnoid hemorrhage with blister aneurysms: endovascular management. Neurol India 2014; 62 (04) 393-399
  • 17 Wang CB, Shi WW, Zhang GX, Lu HC, Ma J. Flow diverter treatment of posterior circulation aneurysms. A meta-analysis. Neuroradiology 2016; 58 (04) 391-400
  • 18 Martínez-Galdámez M, Lamin SM, Lagios KG. et al. Periprocedural outcomes and early safety with the use of the Pipeline Flex embolization device with Shield Technology for unruptured intracranial aneurysms: preliminary results from a prospective clinical study. J NeuroInterventional Surg 2017; 9 (08) 772-776
  • 19 Pierot L, Gubucz I, Buhk JH. et al. Safety and efficacy of aneurysm treatment with the WEB: results of the WEBCAST 2 Study. AJNR Am J Neuroradiol 2017; 38 (06) 1151-1155
  • 20 Clajus C, Strasilla C, Fiebig T, Sychra V, Fiorella D, Klisch J. Initial and mid-term results from 108 consecutive patients with cerebral aneurysms treated with the WEB device. J Neurointerv Surg 2017; 411-417
  • 21 Piotin M, Biondi A, Sourour N, Blanc R. O-036 treatment of intracranial aneurysms with the LUNA AES: midterm clinical and angiographic follow-up. J NeuroInterventional Surg 2014; 6 (Suppl. 01) A19-A20
  • 22 Aguilar PerezM, Bhogal P, Martinez. Moreno R, Bäzner H, Ganslandt O, Henkes H. The Medina Embolic Device: early clinical experience from a single center. J Neurointerv Surg 2017; 9 (01) 77-87
  • 23 Turk AS, Maia O, Ferreira CC, Freitas D, Mocco J, Hanel R. Periprocedural safety of aneurysm embolization with the Medina Coil System: the early human experience. J Neurointerv Surg 2016; 8 (02) 168-172
  • 24 Poncyljusz W, Biliński P, Safranow K. et al. The LVIS/LVIS Jr. stents in the treatment of wide-neck intracranial aneurysms: multicentre registry. J Neurointerv Surg 2015; 7 (07) 524-529
  • 25 Pukenas B, Albuquerque FC, Weigele JB, Hurst RW, Stiefel MF. Use of a new double-lumen balloon catheter for single-catheter balloon-assisted coil embolization of intracranial aneurysms: technical note. Neurosurgery 2011; 69 (01) Suppl Operative ons8-ons12 discussion ons12–ons13
  • 26 Fischer S, Weber A, Carolus A, Drescher F, Götz F, Weber W. Coiling of wide-necked carotid artery aneurysms assisted by a temporary bridging device (Comaneci): preliminary experience. J Neurointerv Surg 2017; 9 (11) 1039-1097
  • 27 Jindal G, Miller T, Beaty N, Puri A, Gandhi D. Ultra-small diameter coils for treatment of intracranial aneurysms. Interv Neuroradiol 2015; 21 (01) 50-54
  • 28 Pérez MA, Bhogal P, Moreno RM. et al. Use of the pCONus as an adjunct to coil embolization of acutely ruptured aneurysms. J Neurointerv Surg 2017; 9 (01) 39-44
  • 29 Lubicz B, Morais R, Alghamdi F, Mine B, Collignon L, Eker OF. The pCONus device for the endovascular treatment of wide neck bifurcation aneurysms. J Neurointerv Surg 2016; 8 (09) 940-944
  • 30 Mukherjee S, Chandran A, Gopinathan A. et al. PulseRider-assisted treatment of wide-necked intracranial bifurcation aneurysms: safety and feasibility study. J Neurosurg 2017; 127 (01) 61-68
  • 31 Gory B, Spiotta AM, Di Paola F. et al. PulseRider for treatment of wide-neck bifurcation intracranial aneurysms: 6-month results. World Neurosurg 2017; 99: 605-609