Predictors of complete occlusion in endovascular coiling of very small intracranial aneurysms.

Authors

Ariana Chacon, Hasna Loulida, Mustafa Ismail, Norito Kenjo, Julio Isidor, Hallmon Hughes, Alejandro Spiotta

Published in

Neuroradiology. Oct 03, 2026. Epub Oct 03, 2026.

Abstract

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.
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.
One-hundred-eighty-five very small intracranial aneurysms (VSAs ≤ 3 mm) (median dome 2.6 mm, 21% < 2 mm) were treated in 185 patients (median age 57.9 years, 71.9% female). 34% presented ruptured; 56% were bifurcation lesions, most commonly at the anterior communicating complex (34.6%). Balloon-assist, stent-assist, and flow diversion were used in 32.4%, 42.7%, and 4.9%, respectively. Immediate complete occlusion was achieved in 53%; at a median 12-month imaging follow-up, complete occlusion was 74.6%, and the retreatment rate was 9.7%. Procedural complications occurred in 10.8% overall, comprising major complications 2.2% (intra-operative rupture 1.1%, thromboembolism 1.1%) and other complications 8.6% ; there were no procedure-related deaths. 93% of patients had a favorable clinical outcome at 13.6-month clinical follow-up. On multivariable analysis, predictors of complete occlusion at last follow-up were complete occlusion at the end of the procedure (OR 3.53), whereas rupture, posterior-circulation location, width, and diameter < 2 mm independently reduced obliteration odds.
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.

PMID:
42828566
Bibliographic data and abstract were imported from PubMed on 04 Oct 2026.

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