Endovascular Management of Wide-Necked Aneurysms

Endovascular management of intracranial aneurysms using detachable platinum coils (Guglielmi detachable coils, Target Therapeutics, Fremont, CA) was introduced in 1990 by Guido Guglielmi, an Italian neurosurgeon. Working in collaboration with Vinuela and others at the University of California at Los Angeles, along with Target Therapeutics, endovascular obliteration of aneurysms became a common practice. Many studies have shown equivalent or improved shortand medium-term outcomes when comparing matched groups of patients undergoing surgical and endovascular therapy. Despite advances, however, the treatment of wide-necked aneurysms (aneurysms with a fundus-to-neck ratio less than 2) remains problematic. Results from early studies using single-dimensional coils alone demonstrated 72% to 80% complete occlusion when the ratio was greater than 2, and 53% when it was lower. Inability to keep coils within these lesions, the posttreatment presence of residual aneurysm, and the occurrence of delayed aneurysm recanalization led investigators to seek new ways to embolize these lesions safely and effectively. This article focuses on techniques and devices aimed at treating widenecked aneurysms.