Endovascular Management of Intracranial Aneurysms

Endovascular treatment of ruptured and unruptured aneurysms continues to provide a minimally invasive method of preventing rupture or re-rupture of intracranial aneurysms. Early trials suggested better outcomes in endovascular treatment of ruptured aneurysms amenable to endovascular or microsurgical treatment, and the technology and techniques of endovascular treatment continues to progress. Traditional coils remain a mainstay of treatment, sometimes augmented with adjuvant stent or balloon assistance. Flow diversion has emerged and proliferated as a technique for embolization of aneurysms without entering the aneurysm sac. Newer techniques including intrasaccular devices hold promise for faster treatment of aneurysms with less reliance on antiplatelet therapies for protection from thromboembolic events. Access via the radial artery provides another method for diagnosis and treatment of the intracranial circulation in addition to traditional femoral access, without the risk of serious groin complications. The evolution of devices, techniques, and antiplatelet therapies continues to propel the field forward in the hope of providing safer treatment for patients.