Abstract
Abstract
Background
Very small intracranial aneurysms (VSAs ≤ 3 mm) are increasingly treated endovascularly, yet procedural fragility and long-term durability remain disputed. Device miniaturization and adjunctive balloon- or stent assistance have improved immediate occlusion, but contemporary single-center outcome data with multivariable modeling are sparse.
Methods
We retrospectively analyzed a prospectively maintained database (2013–2024) for all VSAs treated endovascularly. Demographics, aneurysm morphology, and procedural details were abstracted from digital subtraction angiography (DSA). At the last follow-up, the primary endpoint was complete occlusion; secondary endpoints were favorable functional outcomes, retreatment, and procedural complications. Multivariable logistic regression was adjusted for rupture status, aneurysm width, location, adjunct use, and immediate occlusion.
Results
One-hundred-eighty-five very small intracranial aneurysms (VSAs ≤ 3 mm) (median dome 2.6 mm, 21%
Conclusions
Endovascular coiling of VSAs provides high occlusion and excellent clinical outcomes with minimal morbidity. Anatomical complexity (ultra-small size, posterior circulation) and incomplete initial packing remain targets for technical optimization and prospective evaluation.