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Semin Neurol 2023; 43(03): 480-492
DOI: 10.1055/s-0043-1771299
Review Article

Endovascular and Medical Management of Unruptured Intracranial Aneurysms

Aravind Reddy
1   Department of Neurology, SUNY Upstate Medical University, Syracuse, New York
,
Hesham E. Masoud
1   Department of Neurology, SUNY Upstate Medical University, Syracuse, New York
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Abstract

Unruptured intracranial aneurysms are often discovered incidentally on noninvasive imaging. As use of noninvasive imaging has increased, our understanding of the presumed prevalence of intracranial aneurysms in adults has increased. Incidentally found aneurysms are often asymptomatic; however, they can rarely rupture and cause life-threatening illness. Elective treatment of intracranial aneurysms carries risks which need to be considered along with patient-specific factors (e.g., anatomy, medical comorbidities, personal preferences). In this article, we review the natural history, risk factors for cerebral aneurysm formation and rupture, evidence for medical management, and the safety profile and efficacy of available endovascular treatment options.

Keywords - primary coiling - stent-assisted coiling - balloon-assisted remodeling - flow diversion - CT angiography - MR angiography - surveillance


Publication History

Article published online:
30 July 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Schievink WI. Intracranial aneurysms. N Engl J Med 1997; 336 (01) 28-40
    CrossrefPubMedGoogle Scholar
  • 2 Toth G, Cerejo R. Intracranial aneurysms: review of current science and management. 2018; 23 (03) 276-288
    PubMedGoogle Scholar
  • 3 Wang AS, Campos JK, Colby GP, Coon AL, Lin LM. Cerebral aneurysm treatment trends in National Inpatient Sample 2007-2016: endovascular therapies favored over surgery. J Neurointerv Surg 2020; 12 (10) 957-963
    CrossrefPubMedGoogle Scholar
  • 4 Salem MM, Maragkos GA, Gomez-Paz S. et al. Trends of ruptured and unruptured aneurysms treatment in the United States in post-isat era: a national inpatient sample analysis. J Am Heart Assoc 2021; 10 (04) e016998
    CrossrefPubMedGoogle Scholar
  • 5 Vlak MH, Algra A, Brandenburg R, Rinkel GJ. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis. Lancet Neurol 2011; 10 (07) 626-636
    CrossrefPubMedGoogle Scholar
  • 6 Lindgren AE, Kurki MI, Riihinen A. et al. Hypertension predisposes to the formation of saccular intracranial aneurysms in 467 unruptured and 1053 ruptured patients in Eastern Finland. Ann Med 2014; 46 (03) 169-176
    CrossrefPubMedGoogle Scholar
  • 7 Qureshi AI, Malik AA, Saeed O, Defillo A, Sherr GT, Suri MFK. Hormone replacement therapy and the risk of subarachnoid hemorrhage in postmenopausal women. J Neurosurg 2016; 124 (01) 45-50
    CrossrefPubMedGoogle Scholar
  • 8 Global impact of the COVID-19 pandemic on subarachnoid haemorrhage hospitalisations, aneurysm treatment and in-hospital mortality: 1-year follow-up. J Neurol Neurosurg Psychiatry 2022; 93 (10) 1028-1038
    CrossrefPubMedGoogle Scholar
  • 9 de Rooij NK, Linn FHH, van der Plas JA, Algra A, Rinkel GJE. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 2007; 78 (12) 1365-1372
    CrossrefPubMedGoogle Scholar
  • 10 Wiebers DO, Whisnant JP, Huston III J. et al; International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003; 362 (9378): 103-110
    CrossrefPubMedGoogle Scholar
  • 11 Morita A, Kirino T, Hashi K. et al; UCAS Japan Investigators. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 2012; 366 (26) 2474-2482
    CrossrefPubMedGoogle Scholar
  • 12 Greving JP, Wermer MJH, Brown Jr RD. et al. Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol 2014; 13 (01) 59-66
    CrossrefPubMedGoogle Scholar
  • 13 Vlak MHM, Rinkel GJE, Greebe P, Algra A. Independent risk factors for intracranial aneurysms and their joint effect: a case-control study. Stroke 2013; 44 (04) 984-987
    CrossrefPubMedGoogle Scholar
  • 14 Broderick JP, Brown Jr RD, Sauerbeck L. et al; FIA Study Investigators. Greater rupture risk for familial as compared to sporadic unruptured intracranial aneurysms. Stroke 2009; 40 (06) 1952-1957
    CrossrefPubMedGoogle Scholar
  • 15 Dhar S, Tremmel M, Mocco J. et al. Morphology parameters for intracranial aneurysm rupture risk assessment. Neurosurgery 2008; 63 (02) 185-196 , discussion 196–197
    CrossrefPubMedGoogle Scholar
  • 16 Xiang J, Natarajan SK, Tremmel M. et al. Hemodynamic-morphologic discriminants for intracranial aneurysm rupture. Stroke 2011; 42 (01) 144-152
    CrossrefPubMedGoogle Scholar
  • 17 Etminan N, Brown Jr RD, Beseoglu K. et al. The unruptured intracranial aneurysm treatment score: a multidisciplinary consensus. Neurology 2015; 85 (10) 881-889
    CrossrefPubMedGoogle Scholar
  • 18 Thompson BG, Brown Jr RD, Amin-Hanjani S. et al; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, and Council on Epidemiology and Prevention, American Heart Association, American Stroke Association. Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46 (08) 2368-2400
    CrossrefPubMedGoogle Scholar
  • 19 Matsubara S, Hadeishi H, Suzuki A, Yasui N, Nishimura H. Incidence and risk factors for the growth of unruptured cerebral aneurysms: observation using serial computerized tomography angiography. J Neurosurg 2004; 101 (06) 908-914
    CrossrefPubMedGoogle Scholar
  • 20 van der Kamp LT, Rinkel GJE, Verbaan D. et al. Risk of rupture after intracranial aneurysm growth. JAMA Neurol 2021; 78 (10) 1228-1235
    CrossrefPubMedGoogle Scholar
  • 21 So TY, Dowling R, Mitchell PJ, Laidlaw J, Yan B. Risk of growth in unruptured intracranial aneurysms: a retrospective analysis. J Clin Neurosci 2010; 17 (01) 29-33
    CrossrefPubMedGoogle Scholar
  • 22 Villablanca JP, Duckwiler GR, Jahan R. et al. Natural history of asymptomatic unruptured cerebral aneurysms evaluated at CT angiography: growth and rupture incidence and correlation with epidemiologic risk factors. Radiology 2013; 269 (01) 258-265
    CrossrefPubMedGoogle Scholar
  • 23 Inoue T, Shimizu H, Fujimura M, Saito A, Tominaga T. Annual rupture risk of growing unruptured cerebral aneurysms detected by magnetic resonance angiography. J Neurosurg 2012; 117 (01) 20-25
    CrossrefPubMedGoogle Scholar
  • 24 Etminan N, Rinkel GJ. Unruptured intracranial aneurysms: development, rupture and preventive management. Nat Rev Neurol 2016; 12 (12) 699-713
    CrossrefPubMedGoogle Scholar
  • 25 Burns JD, Huston III J, Layton KF, Piepgras DG, Brown Jr RD. Intracranial aneurysm enlargement on serial magnetic resonance angiography: frequency and risk factors. Stroke 2009; 40 (02) 406-411
    CrossrefPubMedGoogle Scholar
  • 26 Wermer MJH, van der Schaaf IC, Algra A, Rinkel GJE. Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: an updated meta-analysis. Stroke 2007; 38 (04) 1404-1410
    CrossrefPubMedGoogle Scholar
  • 27 Bulsara KR, Jackson D, Galvan GM. Rate of third nerve palsy recovery following endovascular management of cerebral aneurysms. Neurosurg Rev 2007; 30 (04) 307-310 , discussion 310–311
    CrossrefPubMedGoogle Scholar
  • 28 Beck J, Raabe A, Szelenyi A. et al. Sentinel headache and the risk of rebleeding after aneurysmal subarachnoid hemorrhage. Stroke 2006; 37 (11) 2733-2737
    CrossrefPubMedGoogle Scholar
  • 29 Nguyen TN. Management of unruptured intracranial aneurysms and brain arteriovenous malformations. Continuum (Minneap Minn) 2023; 29 (02) 584-604
    PubMedGoogle Scholar
  • 30 Sayer D, Bloom B, Fernando K. et al. An observational study of 2,248 patients presenting with headache, suggestive of subarachnoid hemorrhage, who received lumbar punctures following normal computed tomography of the head. Acad Emerg Med 2015; 22 (11) 1267-1273
    CrossrefPubMedGoogle Scholar
  • 31 Qureshi AI, Mohammad Y, Yahia AM. et al. Ischemic events associated with unruptured intracranial aneurysms: multicenter clinical study and review of the literature. Neurosurgery 2000; 46 (02) 282-289 , discussion 289–290
    CrossrefPubMedGoogle Scholar
  • 32 Cloft HJ, Joseph GJ, Dion JE. Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis. Stroke 1999; 30 (02) 317-320
    CrossrefPubMedGoogle Scholar
  • 33 Wang H, Li W, He H, Luo L, Chen C, Guo Y. 320-detector row CT angiography for detection and evaluation of intracranial aneurysms: comparison with conventional digital subtraction angiography. Clin Radiol 2013; 68 (01) e15-e20
    CrossrefPubMedGoogle Scholar
  • 34 Hirai T, Korogi Y, Ono K. et al. Preoperative evaluation of intracranial aneurysms: usefulness of intraarterial 3D CT angiography and conventional angiography with a combined unit–initial experience. Radiology 2001; 220 (02) 499-505
    CrossrefPubMedGoogle Scholar
  • 35 Sagara Y, Kiyosue H, Hori Y, Sainoo M, Nagatomi H, Mori H. Limitations of three-dimensional reconstructed computerized tomography angiography after clip placement for intracranial aneurysms. J Neurosurg 2005; 103 (04) 656-661
    CrossrefPubMedGoogle Scholar
  • 36 Sailer AMH, Wagemans BAJM, Nelemans PJ, de Graaf R, van Zwam WH. Diagnosing intracranial aneurysms with MR angiography: systematic review and meta-analysis. Stroke 2014; 45 (01) 119-126
    CrossrefPubMedGoogle Scholar
  • 37 Weng HH, Jao SY, Yang CY, Tsai YH. Meta-analysis on diagnostic accuracy of MR angiography in the follow-up of residual intracranial aneurysms treated with Guglielmi detachable coils. Interv Neuroradiol 2008; 14 (02) 53-63
    CrossrefPubMedGoogle Scholar
  • 38 Samaniego EA, Roa JA, Hasan D. Vessel wall imaging in intracranial aneurysms. J Neurointerv Surg 2019; 11 (11) 1105-1112
    CrossrefPubMedGoogle Scholar
  • 39 Edjlali M, Gentric JC, Régent-Rodriguez C. et al. Does aneurysmal wall enhancement on vessel wall MRI help to distinguish stable from unstable intracranial aneurysms?. Stroke 2014; 45 (12) 3704-3706
    CrossrefPubMedGoogle Scholar
  • 40 Lv N, Karmonik C, Chen S. et al. Relationship between aneurysm wall enhancement in vessel wall magnetic resonance imaging and rupture risk of unruptured intracranial aneurysms. Neurosurgery 2019; 84 (06) E385-E391
    CrossrefPubMedGoogle Scholar
  • 41 Liang L, Steinman DA, Brina O, Chnafa C, Cancelliere NM, Pereira VM. Towards the clinical utility of CFD for assessment of intracranial aneurysm rupture - a systematic review and novel parameter-ranking tool. J Neurointerv Surg 2019; 11 (02) 153-158
    CrossrefPubMedGoogle Scholar
  • 42 Salih M, Harris D, Moore J, Thomas A, Ogilvy CS. Current management of small unruptured intracranial aneurysms in the United States: results of a national survey. World Neurosurg 2021; 146: e631-e638
    CrossrefPubMedGoogle Scholar
  • 43 Etminan N, de Sousa DA, Tiseo C. et al. European Stroke Organisation (ESO) guidelines on management of unruptured intracranial aneurysms. Eur Stroke J 2022; 7 (03) V
    CrossrefPubMedGoogle Scholar
  • 44 Tarlov N, Norbash AM, Nguyen TN. The safety of anticoagulation in patients with intracranial aneurysms. J Neurointerv Surg 2013; 5 (05) 405-409
    CrossrefPubMedGoogle Scholar
  • 45 Masoud H, Nair V, Odulate-Williams A. et al. Incidence of aneurysmal subarachnoid hemorrhage with procedures requiring general anesthesia in patients with unruptured intracranial aneurysms. Intervent Neurol 2018; 7 (06) 452-456
    CrossrefPubMedGoogle Scholar
  • 46 Hudson JS, Marincovich AJ, Roa JA, Zanaty M, Samaniego EA, Hasan DM. Aspirin and intracranial aneurysms. Stroke 2019; 50 (09) 2591-2596
    CrossrefPubMedGoogle Scholar
  • 47 Aoki T, Nishimura M, Matsuoka T. et al. PGE(2) -EP(2) signalling in endothelium is activated by haemodynamic stress and induces cerebral aneurysm through an amplifying loop via NF-κB. Br J Pharmacol 2011; 163 (06) 1237-1249
    CrossrefPubMedGoogle Scholar
  • 48 Hasan DM, Mahaney KB, Brown Jr RD. et al; International Study of Unruptured Intracranial Aneurysms Investigators. Aspirin as a promising agent for decreasing incidence of cerebral aneurysm rupture. Stroke 2011; 42 (11) 3156-3162
    CrossrefPubMedGoogle Scholar
  • 49 Can A, Castro VM, Dligach D. et al. Lipid-lowering agents and high HDL (high-density lipoprotein) are inversely associated with intracranial aneurysm rupture. Stroke 2018; 49 (05) 1148-1154
    CrossrefPubMedGoogle Scholar
  • 50 Marbacher S, Schläppi JA, Fung C, Hüsler J, Beck J, Raabe A. Do statins reduce the risk of aneurysm development? A case-control study. J Neurosurg 2012; 116 (03) 638-642
    CrossrefPubMedGoogle Scholar
  • 51 Yoshida K, Uwano I, Sasaki M. et al; SUAVe-PEGASUS trial Investigators. Small unruptured aneurysm verification-prevention effect against growth of cerebral aneurysm study using statin. Neurol Med Chir (Tokyo) 2021; 61 (07) 442-451
    CrossrefPubMedGoogle Scholar
  • 52 Weng JC, Wang J, Li H. et al; Small Unruptured Aneurysms Study Group. Aspirin and growth of small unruptured intracranial aneurysm: results of a prospective cohort study. Stroke 2020; 51 (10) 3045-3054
    CrossrefPubMedGoogle Scholar
  • 53 Weng JC, Wang J, Du X. et al; Small Unruptured Aneurysms Study Group. Safety of aspirin use in patients with stroke and small unruptured aneurysms. Neurology 2021; 96 (01) e19-e29
    CrossrefPubMedGoogle Scholar
  • 54 Juvela S. Growth and rupture of unruptured intracranial aneurysms. J Neurosurg 2018; 131 (03) 843-851
    CrossrefPubMedGoogle Scholar
  • 55 Dandy WE. Intracranial aneurysm of the internal carotid artery: cured by operation. Ann Surg 1938; 107 (05) 654-659
    CrossrefPubMedGoogle Scholar
  • 56 Guglielmi G, Viñuela F, Duckwiler G. et al. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 1992; 77 (04) 515-524
    CrossrefPubMedGoogle Scholar
  • 57 Molyneux AJ, Kerr RS, 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
    CrossrefPubMedGoogle Scholar
  • 58 Molyneux AJ, Kerr RS, Birks J. et al; ISAT Collaborators. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol 2009; 8 (05) 427-433
    CrossrefPubMedGoogle Scholar
  • 59 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
    CrossrefPubMedGoogle Scholar
  • 60 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 (09) 2497-2504
    CrossrefPubMedGoogle Scholar
  • 61 Alshekhlee A, Mehta S, Edgell RC. et al. Hospital mortality and complications of electively clipped or coiled unruptured intracranial aneurysm. Stroke 2010; 41 (07) 1471-1476
    CrossrefPubMedGoogle Scholar
  • 62 Wolstenholme J, Rivero-Arias O, Gray A. et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. Treatment pathways, resource use, and costs of endovascular coiling versus surgical clipping after aSAH. Stroke 2008; 39 (01) 111-119
    CrossrefPubMedGoogle Scholar
  • 63 Naggara ON, White PM, Guilbert F, Roy D, Weill A, Raymond J. Endovascular treatment of intracranial unruptured aneurysms: systematic review and meta-analysis of the literature on safety and efficacy. Radiology 2010; 256 (03) 887-897
    CrossrefPubMedGoogle Scholar
  • 64 Brinjikji W, Rabinstein AA, Lanzino G, Kallmes DF, Cloft HJ. Effect of age on outcomes of treatment of unruptured cerebral aneurysms: a study of the National Inpatient Sample 2001-2008. Stroke 2011; 42 (05) 1320-1324
    CrossrefPubMedGoogle Scholar
  • 65 Brinjikji W, Rabinstein AA, Nasr DM, Lanzino G, Kallmes DF, Cloft HJ. Better outcomes with treatment by coiling relative to clipping of unruptured intracranial aneurysms in the United States, 2001-2008. AJNR Am J Neuroradiol 2011; 32 (06) 1071-1075
    CrossrefPubMedGoogle Scholar
  • 66 Spetzler RF, McDougall CG, Zabramski JM. et al. The barrow ruptured aneurysm trial: 6-year results. J Neurosurg 2015; 123 (03) 609-617
    CrossrefPubMedGoogle Scholar
  • 67 Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR. CARAT Investigators. Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. Stroke 2008; 39 (01) 120-125
    CrossrefPubMedGoogle Scholar
  • 68 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
    CrossrefPubMedGoogle Scholar
  • 69 Nguyen TN, Raymond J, Guilbert F. et al. Association of endovascular therapy of very small ruptured aneurysms with higher rates of procedure-related rupture. J Neurosurg 2008; 108 (06) 1088-1092
    CrossrefPubMedGoogle Scholar
  • 70 Higashida RT, Halbach VV, Dowd CF, Juravsky L, Meagher S. Initial clinical experience with a new self-expanding nitinol stent for the treatment of intracranial cerebral aneurysms: the Cordis Enterprise stent. AJNR Am J Neuroradiol 2005; 26 (07) 1751-1756
    PubMedGoogle Scholar
  • 71 White PM, Lewis SC, Gholkar A. et al; HELPS trial collaborators. Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial. Lancet 2011; 377 (9778): 1655-1662
    CrossrefPubMedGoogle Scholar
  • 72 Boisseau W, Darsaut TE, Fahed R. et al. Stent-assisted coiling in the treatment of unruptured intracranial aneurysms: a randomized clinical trial. AJNR Am J Neuroradiol 2023; 44 (04) 381-389
    CrossrefPubMedGoogle Scholar
  • 73 Samaniego EA, Mendez AA, Nguyen TN. et al. LVIS Jr device for Y-stent-assisted coil embolization of wide-neck intracranial aneurysms: a multicenter experience. Intervent Neurol 2018; 7 (05) 271-283
    CrossrefPubMedGoogle Scholar
  • 74 Spiotta AM, Derdeyn CP, Tateshima S. et al. Results of the ANSWER trial using the PulseRider for the treatment of broad-necked, bifurcation aneurysms. Neurosurgery 2017; 81 (01) 56-65
    CrossrefPubMedGoogle Scholar
  • 75 Becske T, Kallmes DF, Saatci I. et al. Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial. Radiology 2013; 267 (03) 858-868
    CrossrefPubMedGoogle Scholar
  • 76 Limbucci N, Leone G, Renieri L. et al. Expanding indications for flow diverters: distal aneurysms, bifurcation aneurysms, small aneurysms, previously coiled aneurysms and clipped aneurysms, and carotid cavernous fistulas. Neurosurgery 2020; 86 (Suppl. 01) S85-S94
    CrossrefPubMedGoogle Scholar
  • 77 Pierot L, Spelle L, Berge J. et al. SAFE study (Safety and efficacy Analysis of FRED Embolic device in aneurysm treatment): 1-year clinical and anatomical results. J Neurointerv Surg 2019; 11 (02) 184-189
    CrossrefPubMedGoogle Scholar
  • 78 Arthur AS, Molyneux A, Coon AL. et al; WEB-IT Study investigators. The safety and effectiveness of the Woven EndoBridge (WEB) system for the treatment of wide-necked bifurcation aneurysms: final 12-month results of the pivotal WEB Intrasaccular Therapy (WEB-IT) Study. J Neurointerv Surg 2019; 11 (09) 924-930
    CrossrefPubMedGoogle Scholar
  • 79 Goyal N, Hoit D, DiNitto J. et al. How to WEB: a practical review of methodology for the use of the Woven EndoBridge. J Neurointerv Surg 2020; 12 (05) 512-520
    CrossrefPubMedGoogle Scholar
  • 80 Essibayi MA, Lanzino G, Brinjikji W. Safety and efficacy of the woven endobridge device for treatment of ruptured intracranial aneurysms: a systematic review and meta-analysis. AJNR Am J Neuroradiol 2021; 42 (09) 1627-1632
    CrossrefPubMedGoogle Scholar
  • 81 Liebig T, Killer-Oberpfalzer M, Gal G. et al. The safety and effectiveness of the contour neurovascular system (Contour) for the treatment of bifurcation aneurysms: the CERUS study. Neurosurgery 2022; 90 (03) 270-277
    CrossrefPubMedGoogle Scholar
  • 82 Serafin Z, Strześniewski P, Lasek W, Beuth W. Methods and time schedule for follow-up of intracranial aneurysms treated with endovascular embolization: a systematic review. Neurol Neurochir Pol 2011; 45 (05) 421-430
    CrossrefPubMedGoogle Scholar
  • 83 Taki W, Sakai N, Suzuki H. PRESAT group. Factors predicting retreatment and residual aneurysms at 1 year after endovascular coiling for ruptured cerebral aneurysms: Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) in Japan. Neuroradiology 2012; 54 (06) 597-606
    CrossrefPubMedGoogle Scholar
  • 84 Raymond J, Guilbert F, Weill A. et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003; 34 (06) 1398-1403
    CrossrefPubMedGoogle Scholar
  • 85 Nguyen TN, Hoh BL, Amin-Hanjani S, Pryor JC, Ogilvy CS. Comparison of ruptured vs unruptured aneurysms in recanalization after coil embolization. Surg Neurol 2007; 68 (01) 19-23
    CrossrefPubMedGoogle Scholar
  • 86 Serafin Z, Strześniewski P, Lasek W, Beuth W. Comparison of remnant size in embolized intracranial aneurysms measured at follow-up with DSA and MRA. Neuroradiology 2012; 54 (12) 1381-1388
    CrossrefPubMedGoogle Scholar
  • 87 Agid R, Schaaf M, Farb R. CE-MRA for follow-up of aneurysms post stent-assisted coiling. Interv Neuroradiol 2012; 18 (03) 275-283
    CrossrefPubMedGoogle Scholar