Avoiding complications in the endovascular treatment of cerebral aneurysms

Abstract

Embolization of cerebral aneurysms is generally the less invasive treatment option. However, hemorrhagic complications such as intra-procedural rupture and ischemic complications such as thrombosis and embolism may occur with low incidence due to the fragility of the aneurysmal wall and the thrombogenicity generated by catheters and coils. Small aneurysms less than 3 mm in size, large aneurysms, wide-neck aneurysm, stent assisted embolization and acutely ruptured aneurysmal embolization are all at high risk for complication. To prevent complications in such cases, the perioperative administration of an appropriate anti-thrombotic medication and an effective working projection are mandatory. For intra-operative rupture, hemostasis with balloon inflation in front of the aneurysm and continuous coil placement are essential. Subsequent craniotomy might also be considered in some cases. For thrombosis or embolism, intensive anti-thrombotic medication is also mandatory. Subsequent endovascular recanalization should be considered for some cases.