A subarachnoid hemorrhage is bleeding into the subarachnoid space that is the area between the arachnoid membrane and the piamater.
SAH is a common disease with high morbidity and mortality.
The cause of non-traumatic SAH is a rupture of a real cerebral aneurysm in 85% of cases.
The aneurysms tend to be located in the branch of circle of Willis.
Key points about aneurysmal subarachnoid hemorrhage:
A.
The average incidence of subarachnoid hemorrhage is 6 per 100,000 annually.
B.
The group of people at risk for SAH is younger than the population usually affected by stroke and have worse prognosis.
C.
Ruptured intracranial aneurysms may account for 5% of strokes.
D.
The natural history,
if the aneurysm is not treated,
is about 70% mortality and 20% of dependence in survivors due to brain damage.
E.
The neurosurgery history,
if the aneurysm is treated by neurosurgery,
is about 10% of mortality and 20% of dependence is survivors due to brain damage (ISAT study).
The endovascular history,
if the aneurysm is treated by coil embolization,
is about 7.5% of mortality and 15% of dependence due to brain damage (ISAT study).
G.
In endovascular series with unselected patients mortality rate is 7 to 15% and the percentage of patients dependent 60 to 85%.
These values ​​depend directly on clinical grade at admission.
What are very small Aneurysms?
Very small intracranial aneurysms or tiny aneurysms are aneurysms that have 3-mm or less in dome-to-neck ratio.
They have reported a high rate of technical complications in the endovascular treatment of these aneurysms because of the difficulty for catheterization of the aneurysm,
to provide stability of the microcatheter and to achieve the right positioning of the coil.
Surgical treatment is considered first intention classically,
although is also associated with an increased clipping difficulties.
In the International Subarachnoid Aneurysm Trial the very small aneurysms (3 mm) were not included,
and the conclusion that coiling is the preferred treatment does not apply in this cases.
However,
with the advent of more sophisticated endovascular materials,
the growing experience of interventionists,
and an increased use in adjunctive techniques,
such as balloon or stent assisted coiling,
several studies have shown that endovascular treatment of very small aneurysms can be done with acceptable risk.
Overall seems to exist the conclusion that endovascular treatments of very small aneurysms are associated with a greater number of technical complications although the prognosis of patients is similar to the rest of the aneurysms.
Nonetheless,
the efficacy of endovascular treatment in very small aneurysms and the management of very small aneurysms are unclear,
and remain under continued investigation.
Our aim was to analyze our experience in the endovascular treatment of very small intracranial aneurysms associated with SAH and compare with the literature and with the rest of patients with biggest aneurysms.