scholarly journals Endovascular Treatment of Paraclinoid Aneurysms

2011 ◽  
Vol 17 (4) ◽  
pp. 425-430 ◽  
Author(s):  
Y. Sun ◽  
Y. Li ◽  
A-M. Li
Keyword(s):  
Endovascular Treatment ◽  
Brain Infarction ◽  
Endovascular Techniques ◽  
Paraclinoid Aneurysms ◽  
Type Size ◽  
Efficient Alternative ◽  
Ophthalmic Segment Aneurysms ◽  
Incomplete Occlusion ◽  
And Control

The anatomical complexity of the paraclinoid region has made surgical treatment of intracranial ophthalmic segment aneurysms (OSAs) difficult. This study evaluated the safety and efficacy of endovascular treatment of paraclinoid aneurysms. We conducted a retrospective study of 28 patients with 30 aneurysms of the paraclinoid in whom treatment with endovascular techniques was attempted. Patient age, sex, presence of subarachnoid hemorrhage, aneurysm type, size of aneurismal sac and treatment modality were reviewed. Clinical evaluation and control angiography were performed between one and 43 months. Overall, complete occlusion was obtained in 26 aneurysms (86.6%), nearly complete (>90%) occlusion in two aneurysms (6.7%) and incomplete occlusion was observed in two aneurysms (6.7%). All endovascular techniques were successful. Procedure-related complications were observed in two patients (7.1%). Patients underwent follow-up for a mean of 14.8 months (range 1–43 months). Repeated coil treatment was performed in one patient. One patient died of massive brain infarction six days postoperatively and thus no follow-up data were available for this case. In 27 patients with follow-up studies, aneurysm closure was complete in 22 (81.5%) and incomplete in five (18.5%). Endovascular treatment is a safe and efficient alternative approach for paraclinoid aneurysms.

scholarly journals Larger inflow angle and incomplete occlusion predict recanalization of unruptured paraclinoid aneurysms after endovascular treatment

2016 ◽  
Vol 22 (4) ◽  
pp. 383-388 ◽  
Author(s):  
Wenjun Ji ◽  
Aihua Liu ◽  
Xianli Lv ◽  
Liqian Sun ◽  
Shikai Liang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Univariate Analysis ◽  
Digital Subtraction ◽  
Regression Analyses ◽  
Multivariate Logistic Regression ◽  
Paraclinoid Aneurysms ◽  
High Incidence ◽  
Traumatic Aneurysms ◽  
Incomplete Occlusion

Background Unruptured paraclinoid aneurysms have a high incidence of aneurysm recanalization (AR) after endovascular treatment. We aimed to identify the incidence and predictors of AR in these lesions. Methods We retrospectively analyzed consecutive patients with unruptured paraclinoid aneurysms who underwent endovascular treatment between January 2013 and December 2014. Patients with fusiform aneurysms, dissection aneurysms, traumatic aneurysms, or without digital subtraction angiography (DSA) at follow-up, were excluded. AR was defined as any aneurysm remnant that had increased in size or contrast filling that was observed via DSA at the follow-up. Univariate and multivariate logistic regression analyses were performed to assess the predictors of AR. Results We included 145 patients with 150 unruptured paraclinoid aneurysms in the analysis. The incidence of AR was 8.7% (95% confidence interval (CI): 4.7–13.3%) at a mean follow-up of 7.4 months. In the univariate analysis, AR was associated with aneurysm size (odd ratio (OR): 6.098; 95% CI: 1.870–19.886; p = 0.003), location (OR: 3.88; 95% CI: 1.196–12.583; p = 0.024), inflow angle (OR: 6.852; 95% CI: 1.463–32.087; p = 0.015), and Raymond scale (OR: 12.473; 95% CI: 2.7496–56.59; p < 0.001). In the adjusted multivariate analysis, AR was independently predicted by Raymond scale (OR: 9.136; 95% CI: 1.683–49.587; p = 0.001) and inflow angle (OR: 16.159; 95% CI: 3.211–81.308; p = 0.01). Conclusions Unruptured paraclinoid aneurysms had a high incidence of AR after endovascular treatment. An inflow angle of ≥90 degrees and incomplete occlusion were significant predictors of AR.

Open and Endovascular Treatment of Unruptured Carotid-Ophthalmic Aneurysms: Clinical and Radiographic Outcomes

Neurosurgery ◽  
2011 ◽  
Vol 68 (5) ◽  
pp. 1434-1443 ◽  
Author(s):  
Sanjay Yadla ◽  
Peter G. Campbell ◽  
Bartosz Grobelny ◽  
Jack Jallo ◽  
L. Fernando Gonzalez ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Combined Treatment ◽  
Combined Modality Treatment ◽  
Endovascular Techniques ◽  
Patient Demographics ◽  
Radiographic Outcomes ◽  
Major Complications ◽  
Initial Procedure ◽  
Elective Setting

Abstract BACKGROUND: Aneurysms of the carotid-ophthalmic artery present unique challenges to cerebrovascular neurosurgeons given their proximity to vital anatomic structures. OBJECTIVE: To report our experience with a combined-modality treatment of unruptured carotid-ophthalmic aneurysms over a 12-year period. METHODS: A retrospective review of 161 patients who underwent open, endovascular, or combined treatment of 170 aneurysms from January 1997 to July 2009 was conducted. Medical records, operative reports, office notes, and follow-up angiograms were reviewed to obtain data on patient demographics, angiographic results, and clinical outcomes. RESULTS: One hundred forty-seven aneurysms were treated via endovascular techniques; 17 aneurysms (10%) were treated with microsurgical clip ligation; and 6 aneurysms (3.5%) were treated with a combined approach. Of the aneurysms treated via an endovascular approach alone, 81.6% of aneurysms had evidence of ≥ 95% occlusion on initial angiogram. There was a 1.4% rate of major complications associated with the initial procedure. Twenty-six of these aneurysms (18.9%) required further intervention on the basis of early angiographic results. Major complications occurred after 6 of 23 open microsurgical procedures (26.1%), including 2 instances of permanent visual loss. Nine clipped patients had long-term angiographic follow-up; none required further intervention. CONCLUSION: Endovascular treatment of carotid-ophthalmic aneurysms with modern endovascular techniques can be performed safely and efficaciously in the elective setting.

DELAYED VISUAL DEFICITS AND MONOCULAR BLINDNESS AFTER ENDOVASCULAR TREATMENT OF LARGE AND GIANT PARAOPHTHALMIC ANEURYSMS

Neurosurgery ◽  
2008 ◽  
Vol 63 (3) ◽  
pp. 469-475 ◽  
Author(s):  
Raymond D. Turner ◽  
James V. Byrne ◽  
Michael E. Kelly ◽  
Aristotelis P. Mitsos ◽  
Vivek Gonugunta ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Case Series ◽  
Mass Effect ◽  
Endovascular Coiling ◽  
Visual Deterioration ◽  
Paraclinoid Aneurysms ◽  
Bare Platinum Coils ◽  
Platinum Coils

ABSTRACT OBJECTIVE Paraophthalmic aneurysms may exert mass effect on the optic apparatus. Although surgical clipping and endovascular coiling of these aneurysms can be complicated by immediate postoperative visual deterioration, endovascular coil embolization has the unique risk of visual complications later (&gt;24 h) in the perioperative period. METHODS Six patients with a delayed onset of vision loss after technically successful coil embolization of paraophthalmic region aneurysms were identified. All available clinical, angiographic, and cross sectional imaging for these patients, in addition to histopathological data, were reviewed. RESULTS Six patients who underwent endovascular treatment of paraclinoid aneurysms at our institutions developed delayed postoperative visual decline. Four were treated with combination hydrogel-coated and bare platinum coils, one with hydrogel-coated coils, and one with bare platinum coils. Three patients presented with some degree of visual impairment caused by their aneurysms. Catheter angiography performed after the visual decline revealed no etiology in any of the cases. Magnetic resonance imaging was performed in all patients and was unremarkable in two. At follow-up, two had improved, three remained unchanged, and one patient died before any follow-up assessment of her vision. CONCLUSION Both acute and delayed visual disturbances can present after the endovascular treatment of carotid artery paraophthalmic aneurysms. Delayed visual deterioration can be observed up to 35 days after embolization. Although the cause is still undefined, it is likely that the more delayed visual deterioration can be attributed to progression of mass effect and/or perianeurysmal inflammatory change. Our case series raises the possibility that this phenomenon may be more likely with HydroCoil (HydroCoil Embolic System; MicroVention, Aliso Viejo, CA). This possibility should be taken into account by neurointerventionists when selecting a coil type to treat large paraophthalmic aneurysms.

scholarly journals Microsurgical clipping of paraclinoid aneurysms

2020 ◽  
pp. 31-40
Author(s):  
Mugurel Radoi ◽  
Ram Vakilnejad ◽  
Suditu Stefan ◽  
Florin Stefanescu
Keyword(s):  
Endovascular Coiling ◽  
Parent Artery ◽  
Excellent Outcome ◽  
Microsurgical Clipping ◽  
Paraclinoid Aneurysm ◽  
Postoperative Control ◽  
Paraclinoid Aneurysms ◽  
Operative Control ◽  
Ophthalmic Segment Aneurysms

Background. Paraclinoid aneurysm is a nonspecific term that includes ophthalmic segment aneurysms and distal cavernous internal carotid artery (ICA) aneurysms. The literature mostly described the frequency to be in the range of 1.3-5%. and a high incidence of being multiple or having a large size. Methods. A retrospective review of 18 consecutive patients surgically treated for paraclinoid aneurysm was performed. The data of all our consecutive patients were searched to obtain patient and aneurysm characteristics, treatment details, complications and follow up. Clinical outcome was graded according to the modified Rankin scale. The follow-up period varied widely from 3 to 62 months (mean 26 months). Results. Surgical clipping was performed for 15 ruptured paraclinoid aneurysms; only in 3 cases the aneurysm was unruptured. Post-operative control angiography was performed in 10 patients (55.56%), from which we reported a full occlusion of the aneurysm in 9 patients (90%). Best results were obtained in patients who preoperatively were included in 1st and 2nd grade of Hunt & Hess scale. Two months postoperative follow-up was complete for all but one patient who died 12 days after surgery, from cerebral ischemia resulting from severe cerebral vasospasm. There were excellent and good results (mRS 0–2) in 88% of the cases (15 out of 17 patients) at two months follow-up, and 94% (16 out of 17 patients) at six months follow-up. Three patients with slight disabilities, ranked mRS 1-2 at two months follow-up, improved to mRS 0, with no symptoms at all, at 6 months postoperative control. All 3 patients with a surgically treated non-ruptured paraclinoid aneurysm had an excellent outcome (mRS 0). Conclusions. Most appropriate treatment is to occlude aneurysms without compromising patency of the parent artery. Anterior clinoidectomy and microsurgical clipping can still be a standard treatment despite of recent development of endovascular coiling procedures.

Predictive factors of incomplete aneurysm occlusion after endovascular treatment with the Pipeline embolization device

2020 ◽  
Vol 132 (5) ◽  
pp. 1598-1605 ◽  
Author(s):  
Georgios A. Maragkos ◽  
Luis C. Ascanio ◽  
Mohamed M. Salem ◽  
Sricharan Gopakumar ◽  
Santiago Gomez-Paz ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Predictive Factors ◽  
Cohort Analysis ◽  
Multivariable Analysis ◽  
Pipeline Embolization Device ◽  
Unruptured Aneurysms ◽  
Maximal Diameter ◽  
Aneurysm Occlusion ◽  
Incomplete Occlusion

OBJECTIVEThe Pipeline embolization device (PED) is a routine choice for the endovascular treatment of select intracranial aneurysms. Its success is based on the high rates of aneurysm occlusion, followed by near-zero recanalization probability once occlusion has occurred. Therefore, identification of patient factors predictive of incomplete occlusion on the last angiographic follow-up is critical to its success.METHODSA multicenter retrospective cohort analysis was conducted on consecutive patients treated with a PED for unruptured aneurysms in 3 academic institutions in the US. Patients with angiographic follow-up were selected to identify the factors associated with incomplete occlusion.RESULTSAmong all 3 participating institutions a total of 523 PED placement procedures were identified. There were 284 procedures for 316 aneurysms, which had radiographic follow-up and were included in this analysis (median age 58 years; female-to-male ratio 4.2:1). Complete occlusion (100% occlusion) was noted in 76.6% of aneurysms, whereas incomplete occlusion (≤ 99% occlusion) at last follow-up was identified in 23.4%. After accounting for factor collinearity and confounding, multivariable analysis identified older age (> 70 years; OR 4.46, 95% CI 2.30–8.65, p < 0.001); higher maximal diameter (≥ 15 mm; OR 3.29, 95% CI 1.43–7.55, p = 0.005); and fusiform morphology (OR 2.89, 95% CI 1.06–7.85, p = 0.038) to be independently associated with higher rates of incomplete occlusion at last follow-up. Thromboembolic complications were noted in 1.4% and hemorrhagic complications were found in 0.7% of procedures.CONCLUSIONSIncomplete aneurysm occlusion following placement of a PED was independently associated with age > 70 years, aneurysm diameter ≥ 15 mm, and fusiform morphology. Such predictive factors can be used to guide individualized treatment selection and counseling in patients undergoing cerebrovascular neurosurgery.

Endovascular Treatment of Paraclinoid Aneurysms: Experience with 73 Patients

Neurosurgery ◽  
2003 ◽  
Vol 53 (1) ◽  
pp. 14-24 ◽  
Author(s):  
Hae Kwan Park ◽  
Michael Horowitz ◽  
Charles Jungreis ◽  
Amin Kassam ◽  
Chris Koebbe ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Endovascular Procedures ◽  
Positive Impact ◽  
Medical Center ◽  
Length Of Hospital Stay ◽  
Partial Occlusion ◽  
Complete Occlusion ◽  
Paraclinoid Aneurysms ◽  
The University

Abstract OBJECTIVE Aneurysms arising from the internal carotid artery in close relation to the clinoid process have been called paraclinoid aneurysms. The surgical management of these aneurysms poses technical challenges, and such patients are frequently referred for endovascular treatment. We reviewed our experience with endovascular coil embolization of paraclinoid aneurysms to evaluate the safety and efficacy of this treatment modality. METHODS From December 1993 to May 2002, 70 patients underwent endovascular procedures with detachable coils for 73 paraclinoid aneurysms (8 ruptured, 65 unruptured) at the University of Pittsburgh Medical Center and the University of Texas Southwestern Medical Center. A retrospective review of the medical records, outpatient charts, and operative reports was performed. Angiographic outcome was determined at the end of each procedure and by review of follow-up angiograms. Clinical assessments and outcomes are reported according to the Glasgow Outcome Scale (GOS). RESULTS Immediate angiographic outcomes for 73 paraclinoid aneurysms demonstrated complete occlusion in 53 (72.6%), near-complete occlusion in 6 (8.2%), and partial occlusion in 14 (19.2%). Nine aneurysms required more than one coiling session to complete treatment; 8 of these aneurysms required two sessions and 1 required four, for a total of 84 endovascular procedures. Follow-up angiograms could be obtained in 49 patients with 52 paraclinoid aneurysms. During the follow-up period, 6 aneurysms demonstrating partial occlusion and 3 demonstrating near-complete occlusion showed spontaneous progression of thrombosis to complete occlusion. Twelve aneurysms initially demonstrating complete occlusion (5 aneurysms), near-complete occlusion (3 aneurysms), or partial occlusion (4 aneurysms) showed coil compaction requiring retreatment. Of these 12 aneurysms that demonstrated coil compaction, 3 were treated with surgery and 9 with coil repacking. The final angiographic outcomes, determined on the last available follow-up angiograms of 49 aneurysms, excluding 3 surgically clipped aneurysms, showed complete occlusion in 43 (87.8%), near-complete occlusion in 3 (6.1%), and partial occlusion in 3 (6.1%). The angiographic follow-up period ranged from 4 to 54 months (mean, 13.9 mo). Morbidity and mortality rates related to 84 endovascular procedures were 8.3 and 0%, respectively. There were no recurrent or new subarachnoid hemorrhages in 63 patients in whom clinical follow-up could be performed during a mean clinical follow-up period of 14.4 months. The final clinical outcomes demonstrated a GOS score of 5 (good recovery) in 56 patients (88.9%), a GOS score of 4 (moderate disability) in 2 (3.2%), and a GOS score of 3 (severe disability) in 1 (1.6%). Four patients (6.3%) died of unrelated causes. The average period of hospitalization was 17.8 days in patients with acutely ruptured aneurysms and 3.5 days in patients with unruptured or retreated aneurysms. CONCLUSION The results of this study indicate that endovascular treatment is a safe and effective therapeutic alternative in ruptured and unruptured paraclinoid aneurysms. The endovascular treatment may also confer a positive impact in terms of the length of hospital stay.

scholarly journals The role of endovascular treatment in unruptured basilar tip aneurysms

2016 ◽  
Vol 23 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Huijian Ge ◽  
Xianli Lv ◽  
Hengwei Jin ◽  
Zhihua Tian ◽  
Youxiang Li ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Endovascular Treatment ◽  
Potential Risk ◽  
Complete Occlusion ◽  
Delayed Hemorrhage ◽  
Hemorrhagic Events ◽  
Occlusion Rate ◽  
The Mean ◽  
Incomplete Occlusion

Objective This study was to evaluate the safety and efficiency of endovascular treatment of unruptured basilar tip aneurysms. Methods We retrospectively reviewed consecutive 79 cases of unruptured basilar tip aneurysms in our center between 2009 and 2014. The patients’ clinical and imaging information were recorded. Complications, initial occlusion rate, clinical outcomes and the predictors were retrospectively analyzed. Results Thirty-five cases received conservative treatment and 44 cases were treated by endovascular embolization. In the conservative treatment group, six (19.4%) of 31 basilar tip aneurysms ruptured and resulted in five deaths (16.1%) during the mean 18.1-month follow-up (range from 1 to 60 months). Among the endovascularly treated cases, 24 (54.5%) achieved initial complete occlusion and no delayed hemorrhagic events occurred during the mean 33.6-month follow-up (range from 10 to 68 months). For 20 (45.5%) incompletely occluded cases, five postoperative or delayed hemorrhagic events and two mass effect events resulted in six deaths. There were no statistical significant differences in hemorrhagic events ( p = 0.732) and mortality ( p = 0.502) between the incomplete occlusion group and untreated group. Large aneurysm size (≥10 mm) was an independent predictor for incomplete occlusion ( p = 0.002), which had a potential risk of postoperative or delayed hemorrhage. On univariate analysis, initial occlusion rate and aneurysm size were found to be associated with clinical outcomes ( p = 0.042 and 0.015). Conclusion Complete occlusion for unruptured basilar tip aneurysm proved to be a safe and effective therapeutic method that could eliminate the potential risk of postoperative or delayed hemorrhage.

scholarly journals Endovascular Treatment of Ruptured Paraclinoid Aneurysms: Results, Complications, and Follow-Up

2011 ◽  
Vol 33 (4) ◽  
pp. 632-637 ◽  
Author(s):  
I. Loumiotis ◽  
P.I. D'Urso ◽  
R. Tawk ◽  
H.J. Cloft ◽  
D.F. Kallmes ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Paraclinoid Aneurysms

Flow Diverters for Treatment of 160 Ophthalmic Segment Aneurysms: Evaluation of Safety and Efficacy in a Multicenter Cohort

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 726-732 ◽  
Author(s):  
Christoph J. Griessenauer ◽  
Ronie L. Piske ◽  
Carlos E. Baccin ◽  
Benedito J.A. Pereira ◽  
Arra S. Reddy ◽  
...  
Keyword(s):  
Flow Diverter ◽  
Safety And Efficacy ◽  
Complete Occlusion ◽  
Multicenter Cohort ◽  
Retreatment Rate ◽  
Permanent Morbidity ◽  
Ophthalmic Segment Aneurysms ◽  
Incomplete Occlusion ◽  
Flow Diverters

Abstract BACKGROUND: Treatment of ophthalmic segment aneurysms (OSA) remains challenging. Flow diverter stents (FDS) have evolved as a promising endovascular treatment option for aneurysms of the internal carotid artery and are associated with high occlusion rates and a favorable morbidity and mortality profile. OBJECTIVE: To determine safety and efficacy of FDS for OSA in a large, multicenter cohort. METHODS: A retrospective analysis of prospectively maintained databases of 127 consecutive patients harboring 160 OSA treated with FDS was performed. Aneurysms were classified based on location and morphology. Follow-up with digital subtraction angiography (DSA) was performed 6 to 18 months after treatment. RESULTS: Follow-up DSA was available for 101 (63.1%) aneurysms with a mean follow-up of 18 months. Complete occlusion was observed in 90 aneurysms (89.1%), near-complete occlusion (&gt;95%) in 3 (3%), and incomplete occlusion (&lt;95%) in 8 aneurysms (7.9%). One aneurysm was retreated with another FDS (0.9%). No risk factors for incomplete occlusion were identified. The OA was occluded at the latest follow-up in 6 cases (7.1%). Permanent morbidity occurred in 4 patients (3.1%), and there was no mortality related to the FDS procedure. CONCLUSION: Treatment of OSA with FDS was found to be safe and effective. The retreatment rate was extremely low and aneurysms that occluded did not reanalyze.

Evaluation of ischemic lesion prevalence after endovascular treatment of intracranial aneurysms, as documented by 3-T diffusion-weighted imaging: a 2-year, single-center cohort study

2018 ◽  
Vol 128 (4) ◽  
pp. 982-991 ◽  
Author(s):  
Christina Iosif ◽  
Jean-Christophe Lecomte ◽  
Eduardo Pedrolo-Silveira ◽  
George Mendes ◽  
Marie-Paule Boncoeur Martel ◽  
...  
Keyword(s):  
Cohort Study ◽  
Endovascular Treatment ◽  
Diffusion Weighted Imaging ◽  
Intracranial Aneurysms ◽  
Published Data ◽  
Single Center ◽  
Endovascular Techniques ◽  
Ischemic Lesion ◽  
Diffusion Weighted

OBJECTIVEEven though published data exist concerning the prevalence of ischemic lesions detected by diffusion-weighted imaging (DWI) following endovascular treatment of intracranial aneurysms, a single-center cross-evaluation of the different endovascular techniques has been lacking. The authors sought to prospectively evaluate the prevalence and clinical significance of ischemic lesions occurring after endovascular treatment of intracranial aneurysms and to compare the safety and effectiveness of a broad spectrum of currently accepted endovascular techniques in a single-center setting.METHODSThis was a prospective cohort study involving consecutive patients treated for intracranial aneurysms exclusively by endovascular means, excluding treatments in the acute rupture phase, in a center featuring an endovascular-only treatment policy for intracranial aneurysms. All patients underwent MRI, including a 3-directional DWI sequence, before treatment, 24 hours postprocedure, and 6 months following endovascular embolization. Selective angiography was performed at 6 months’ follow-up.RESULTSFrom January 2012 through December 2013, 164 aneurysms were treated in 128 consecutive patients. Endovascular techniques included coiling (14.6%), balloon-assisted coiling (20.1%), stent-assisted coiling (3.7%), low-profile stent-assisted coiling, flow diversion (38.4%), and very complex treatments (6.1%) involving 2 stents in Y or T configurations. On postprocedure MRI, the rates of occurrence of new DWI-positive lesions were 64.3% for coiling, 54.5% for remodeling, 61.1% for stent-assisted coiling, 53.7% for flow-diverting stents, and 75% for very complex treatments (p = 0.4962). The 6-month procedure-related morbidity and mortality rates were 6.25% and 0%, respectively. At 6 months’ follow-up, 93% of the patients had modified Rankin Scale (mRS) scores of 0–2. Very complex treatments offered a higher complete occlusion rate (100%) than all other techniques (66.7%–88.9%). Age and length of procedure were independent factors for DWI lesion occurrence. The diameter of DWI lesions on 24-hour postprocedure MRI was positively correlated with mRS score at discharge. Among the DWI-positive lesions measuring less than 2 mm in diameter on the 24-hour MRI, 44.12% had regressed at 6 months.CONCLUSIONSProcedure-related DWI lesions are far more often encountered in silent forms than they are clinically evident. They do not seem to be significantly correlated with procedure-related complications, nor do they seem to impair clinical outcome, regardless of the endovascular technique. Small lesions (< 2 mm in diameter) may regress within 6 months. The use of the most adapted technique, in terms of aneurysm configuration, results in significant total occlusion rates, with acceptable safety.

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