Endovascular Management of Cerebral Aneurysms

Abstract

During the last decade, the field of endovascular surgery for the treatment of neurovascular disorders in general, and for cerebral aneurysms in particular, has undergone tremendous growth. As new technologies are developed and more experience is gained by trained endovascular therapists, more and more lesions will be able to be treated by less invasive methods. Improvements in catheter, guidewire and delivery system design, the development of various embolic agents and the technical advancements in imaging equipment have all contributed to the advancement of the field. Today, the endovascular treatment of cerebral aneurysms is a reliable, reproducible and well-accepted technique. Presently, most endovascular aneurysm treatments involve the use of detachable balloons and/or metallic coils. Detachable balloons are primarily used for deconstructive procedures or aneurysm neck protection. Detachable coils varying in size, length, flexibility, and configuration can now be reliably placed within an aneurysm and detached either mechanically or by electrolysis in a controlled fashion. The evolving techniques of endovascular aneurysm treatment including the development and use of precipitates, stents of various designs, neck protection and remodeling, aneurysm liners, liquid polymers, hydrogels, aneurysm neck protection, micro-anastomoses, bioactive manipulations to endovascular devices as well as real-time three-dimensional imaging will be discussed.