Endovascular embolization of small ruptured intracranial aneurysms using a biplane angiographic system with three-dimensional rotational digital subtraction angiography

Endovascular coiling of small, ruptured intracranial aneurysms is controversial because of technical difficulties. We analyzed the clinical and angiographic effects of endovascular treatment of 39 small (⩽5 mm) ruptured intracranial aneurysms (in 37 patients) at our institution between March 2004 and March 2007. Procedures were carried out on a biplane angiographic system with three-dimensional rotational digital subtraction angiography. Immediately after embolization, 30 aneurysms were completely occluded and nine had a residual neck. The volumetric percentage occlusion was 45.2 ± 9.7%. Angiographic and clinical follow-up was at 6.1 months and 15.9 months, respectively. Delayed rebleeding was not observed. Complications directly related to the procedure were encountered in two patients (one coil migration and one intraoperative rupture). For 34 patients, the final outcome was excellent or good, one suffered a moderate disability, one a severe disability and one patient died. The results suggest that endovascular embolization is effective and safe for patients with small ruptured intracranial aneurysms.