Current and future endovascular treatments for cerebral aneurysms

Abstract

Various novel devices to overcome recanalization following endovascular coiling of cerebral aneurysms have been developed. Among the so-called next generation of coils, hydrogel-coated coils were shown to be more effective than bare platinum coils in the GREAT trial. Neck-bridging stents have expanded the indications for aneurysm coiling and have been shown to significantly reduce recanalization. Use of flow diverter devices has almost completely overcome the recanalization phenomenon. The concept of treating an aneurysm by flow diversion through the parent vessel without accessing the aneurysm lumen has totally changed our treatment paradigm. However, antiplatelet therapy remains mandatory to avoid ischemic complications. In the near future, intrasaccular devices that leave no foreign material in the vessel are expected, which would possibly negate the need for antiplatelet therapy.