Cerebrovascular disease: Edited by Cornelius Weiller and Jens FiehlerFactors affecting outcome after endovascular treatment of intracranial aneurysmsFiehler, Jensa; Byrne, James VbAuthor Information aDepartment of Neuroradiology, University Medical Center Hamburg, Hamburg, Germany bDepartment of Neuroradiology, University of Oxford, The John Radcliffe Hospital, Oxford, UK Correspondence to Jens Fiehler, MD, PhD, Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany Tel: +49 040 42803 2746; fax: +49 040 42803 4640; e-mail: [email protected] Current Opinion in Neurology: February 2009 - Volume 22 - Issue 1 - p 103-108 doi: 10.1097/WCO.0b013e32831af1c1 Buy Metrics Abstract Purpose of review This brief review highlights some factors affecting the short-term and long-term outcomes after endovascular treatment (EVT) of patients with intracranial aneurysms. Recent findings The principal procedural risks associated with EVT are symptomatic thromboembolic events affecting 2.4–5.2% of treatments, and aneurysm perforation which occurs in 0.5–2.4% of the patients with unruptured aneurysms and 2.3–6.5% of patients with subarachnoid haemorrhage. The risk of subsequent aneurysm recurrence requiring retreatment is about 10% and does not negate the morbidity advantage (relative to surgical clipping) of the initial EVT. This risk is about three-fold greater in aneurysms with a neck width more than 4 mm and sac maximum diameter greater than 10 mm. The incidence of rebleeding after EVT is 0.11–0.32% per annum and is probably lower if EVT achieves complete occlusion. Summary EVT dramatically reduces the risk of rebleeding in patients with subarachnoid haemorrhage. Treatment risks and rates of incomplete occlusions are increased in ruptured in comparison with unruptured aneurysms. Large aneurysms have higher risk of procedural thromboembolism, incomplete treatment and rate of recurrences with strong interdependence between these variables. The low risk of rebleeding in patients with subarachnoid haemorrhage is probably increased in incompletely treated aneurysms and in patients revealing aneurysm growth over time. © 2009 Lippincott Williams & Wilkins, Inc.