From the Guidelines
For patients with saccular (berry) aneurysms, primary coiling is recommended in preference to clipping to improve 1-year functional outcome, especially for those with good-grade aneurysms of the anterior circulation equally suitable for both treatment options 1. The treatment approach for saccular aneurysms is multifaceted, considering factors such as the aneurysm's location, size, and the patient's overall health status.
- For ruptured aneurysms, the goal is to prevent rebleeding and manage complications, with surgical clipping or endovascular coiling being primary treatment strategies, as indicated by the American Heart Association/American Stroke Association guideline 1.
- The choice between clipping and coiling depends on various factors including aneurysm location, size, and the patient's condition, with coiling often preferred for posterior circulation aneurysms and clipping considered for younger patients or those with specific aneurysm characteristics 1.
- For unruptured aneurysms, the decision to treat is based on the risk of rupture, which is influenced by aneurysm size, location, and patient factors, with larger aneurysms or those in high-risk locations typically requiring intervention.
- In cases where the aneurysm is not amenable to clipping or primary coiling, alternative endovascular treatments such as stent-assisted coiling or flow diverters may be considered, although their use is generally reserved for specific scenarios due to the risk of complications 1.
- Post-treatment care includes monitoring for recurrence, managing risk factors like hypertension and smoking, and preventing vasospasm, which may involve the use of medications like nimodipine 1.
From the Research
Treatment Options for Saccular Aneurysm
The treatment for a saccular (also known as berry) aneurysm can be achieved through various methods, including:
- Microsurgical clipping: a surgical technique where a clip is placed around the neck of the aneurysm to prevent blood flow into it 2
- Endovascular coiling: a minimally invasive procedure where a catheter is used to deliver coils into the aneurysm, blocking blood flow into it 2, 3
- Flow diversion: a technique using devices such as the Pipeline Embolization Device (PED) to divert blood flow away from the aneurysm, promoting occlusion 4
- Intrasaccular flow disruptor devices: a new class of endovascular therapy, including devices such as the Woven EndoBridge (WEB) and Artisse, which have shown effectiveness in treating complex aneurysms 3
- Coiling followed by chimney endovascular aortic repair (ch-EVAR): a stepwise endovascular repair technique used to treat saccular aneurysms of the aortic arch 5
Considerations for Treatment Selection
The choice of treatment depends on various factors, including:
- Aneurysm size and location
- Shape of the aneurysm (e.g., narrow neck and ratio of neck diameter to sac diameter)
- Patient age and overall health
- Presence of subarachnoid hemorrhage or vasospasm
- Risk of procedural-related structural injury, with clipping associated with higher rates of injury compared to coiling 6