Endovascular Treatment Strategies for Intracranial Aneurysms

Endovascular therapy has transformed the management of intracranial aneurysms by offering minimally invasive alternatives to open surgery. Techniques range from simple coil embolisation to complex flow‐diverting stents and intrasaccular devices. Coil embolisation remains the most established approach, inducing intra‐aneurysmal thrombosis while preserving parent vessel patency. Stent‐assisted coiling was introduced to treat wide‐neck and complex aneurysms by scaffolding coils and reducing recanalisation. Flow‐diverting stents promote endothelialisation across the aneurysm neck, redirecting blood flow out of the sac and facilitating long‐term occlusion. Intrasaccular flow disruptors, such as woven nitinol mesh devices placed within the aneurysm itself, aim to simplify treatment of bifurcation lesions without the need for dual antiplatelet therapy. Advances in imaging and computational modelling have enhanced risk stratification and device selection by simulating haemodynamic environments and predicting occlusion durability. Growth in adjunctive technologies—such as detachable covered stents, balloon‐remodelling techniques and bioactive coils—continues to expand the armamentarium. Collectively, these strategies have reduced periprocedural morbidity, improved aneurysm occlusion rates and broadened treatment to anatomies once deemed unsuitable for endovascular approaches.

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Endovascular Treatment Strategies for Intracranial Aneurysms publication trend

The graph below shows the total number of articles in endovascular treatment strategies for intracranial aneurysms across all publications each year (not limited to Nature Index journals).

Technical terms

Endovascular coiling: Deployment of detachable metal coils into the aneurysm sac to promote clot formation and exclude the lesion from circulation.

Stent‐assisted coiling: Use of an intracranial stent to bridge the aneurysm neck, preventing coil prolapse and enhancing packing density.

Flow diverter: A densely braided endoluminal stent that redirects blood flow along the parent artery, leading to progressive thrombosis of the aneurysm.

Intrasaccular flow disruptor: A mesh device placed entirely within the aneurysm sac to disrupt inflow jets and induce occlusion without crossing the parent vessel.

Computational fluid dynamics (CFD): Numerical simulation of blood flow within vessels and aneurysms to assess haemodynamic forces and predict growth or rupture risk.

Wall shear stress (WSS): The tangential force exerted by flowing blood on the endothelial surface, implicated in aneurysm initiation, growth and remodelling.

References

1. Deep Learning–Assisted Diagnosis of Cerebral Aneurysms Using the HeadXNet Model. JAMA Network Open (2019).
2. Safety and Efficacy of Aneurysm Treatment with the WEB: Results of the WEBCAST 2 Study. American Journal of Neuroradiology (2017).
3. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. The Lancet Neurology (2009).