Coiling Embolization of Small Ruptured Intracranial Aneurysms (SRA): Clinical Outcomes and Complications

Objective: To evaluated the clinical outcomes, complications, and factors associated with unfavorable outcomes in patients undergoing coil embolization for small ruptured intracranial aneurysms (SRA). Materials and Methods: This study conducted a retrospective review of patients with ruptured true saccular intracranial aneurysms who underwent coiling embolization. The authors collected clinical outcomes, complications, and factors associated with unfavorable outcomes. Results: Fifty patients, 35 (70%) of whom were women, with a mean age of 55.7 years, were included in this study. Clinical presentation according to the Hunt and Hess scale showed grade I-II in 26 patients (52%) and grade III-V in 24 (48%). Treatment modalities included simple coiling and stent-assisted coiling in 47 patients (94%) and 3 (6%), respectively. Clinical outcomes demonstrated favorable outcomes (mRS 0-2) in 37 patients (74%) and unfavorable outcomes (mRS 3-6) in 13 patients (26%). The mean aneurysm dome size and mean neck size were 3.1±0.9 and 2.2±0.7 mm, respectively, with a mean dome-to-neck ratio of 1.4±0.3 and mean aspect ratio of 1.5±0.4. Complications occurred in five patients (10%): one suffered an intraprocedural aneurysm rupture, and there were four thromboembolic events. No cases of rebleeding were observed. In the multivariate analysis, age >60 years (p=0.04) and Hunt and Hess grade III-V (p=0.02) were independent factors associated with unfavorable outcomes. Conclusion: Coiling embolization of SRA appears to be safe and effective, even during the early phase of an endovascular neurosurgeon’s experience. This favorable safety profile is probably attributable to ongoing advancements in endovascular devices and procedural techniques. Advanced age (>60 years) and higher clinical severity, defined as Hunt and Hess grades III-V, were significantly associated with unfavorable outcomes.