The results of endovascular occlusion of ruptured tiny cerebral aneurysms of proximal localization

Surgical treatment of ruptured tiny aneurysms (TA) is a significant problem of vascular neurosurgery due to the large number of technical difficulties, complications and high mortality.

THE PURPOSE OF THE STUDY: to substantiate the efficacy and safety of endovascular occlusion of ruptured MA in comparison with cerebral aneurysms (CA) of normal size.

MATERIALS AND METHODS: a retrospective analysis of the treatment of 639 patients with aneurysmal subarachnoid hemorrhage (SAH) due to CA rupture of proximal localization less than 3 mm (the first group) and aneurysms from 3 to 15 mm (the second group) was performed. The first group included 44 patients, and the second group, respectively, 491 patients. All patients underwent clinical, laboratory and instrumental examinations according to the current clinical guidelines. In all patients, endovascular occlusion with detachable coils was chosen as a method of surgical treatment. Assessment of the results of treatment was carried out at the time of discharge from the hospital and after 12 months.

RESULTS AND DISCUSSION: middle and severe severity of the condition was prevailed in the patients included in the study. Statistical analysis didn’t performed significant correlation between in the initial severity of the condition, the type of hemorrhage, the severity of cerebral angiospasm in the severity of the condition at admission, outcomes of treatment of patients with aneurysmal SAH with the size of the CA (in the nearest and delay periods). The survival analysis also didn’t determine statistically significant differences depending on the size of CA. However, the frequency of intraoperative complications and adverse outcomes in the near term in patients with TA was significantly higher. The survival analysis also did not determine statistically significant differences depending on the size of the CA.

CONCLUSIONS: endovascular occlusion of TA is an effective and safe method of surgical treatment, and the problem of ruptured TA remains an urgent and ambiguous issue of vascular neurosurgery. The frequency of TA rupture is probably somewhat underestimated, and a number of technical difficulties in surgical treatment once again prove the need for in depth research on this issue.

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