Endovascular treatments for intracranial aneurysms

During the last 10 years, the development of flexible microcatheters which can navigate cerebral vessels to lesions deep within the brain, has allowed the treatment of an increasing range of intracranial pathologies, including aneurysms. Techniques to embolize aneurysms, either by occlusion of their parent artery or endosaccular packing with its preservation, have evolved largely in order to treat inoperable aneurysms. Endosaccular packing with thrombogenic coils has recently allowed embolization of smaller aneurysms to be performed in patients acutely ill after subarachnoid haemorrhage. The procedural morbidity associated with these endovascular treatments are less dependent on aneurysm site than conventional neurosurgical clipping and initial results are comparable. These developments are challenging current thinking on the surgical management of patients with intracranial aneurysms. This review describes the evolution and practice of current endovascular treatments and their possible implications for the future of neuroradiology.