Endovascular Evolution in Subarachnoid Hemorrhage Management: A Comprehensive Review of Transitions from Coiling to Contemporary Stent-Assisted Therapies
Main Article Content
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) remains a critical neurosurgical emergency characterized by high morbidity and mortality, demanding continuous refinement of endovascular techniques. This extensive review synthesizes current evidence on the paradigm shift from simple coil embolization to advanced stent-assisted interventions for intracranial aneurysm management. The discourse navigates through foundational principles of Guglielmi detachable coil occlusion, highlighting its established role in securing ruptured aneurysms while scrutinizing limitations in complex morphologies. Subsequently, the analysis progresses to the integration of intracranial stents—focusing on flow-diverting and intrasaccular devices—which have redefined therapeutic boundaries for wide-necked, fusiform, or previously untreatable lesions. Contemporary literature underscores nuanced considerations in peri-procedural antiplatelet regimens, hemodynamic management, and long-term angiographic outcomes. By examining recent multicenter trials and meta-analyses, this review elucidates evolving indications, safety profiles, and cost-efficacy dynamics, ultimately framing a sophisticated understanding of modern neurointerventional strategy. The synthesis aims to equip clinicians with evidence-based insights for tailored therapeutic decision-making in a rapidly advancing field.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Krishnamurthi, R.V.; Moran, A.E.; Feigin, V.L.; Barker-Collo, S.; Norrving, B.; Mensah, G.A.; Taylor, S.; Naghavi, M.; Forouzanfar, M.H.; Nguyen, G.; et al. Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Adults Aged 20–64 Years in 1990–2013: Data from the Global Burden of Disease 2013 Study. Neuroepidemiology 2015, 45, 190–202.
II. Qureshi, A.I.; Tuhrim, S.; Broderick, J.P.; Batjer, H.H.; Hondo, H.; Hanley, D.F. Spontaneous Intracerebral Hemorrhage. N. Engl. J. Med. 2001, 344, 1450–1460.
III. Rajashekar, D.; Liang, J.W. Intracerebral Hemorrhage. In StatPearls; StatPearls Publishing, 2021; Available online: http://www.ncbi.nlm.nih.gov/books/NBK553103/ (accessed on 22 August 2021).
IV. Marden, F.A.; Roy, S.S. Endovascular management of intracerebral and subarachnoid hemorrhage. Curr. Treat. Options Cardiovasc. Med. 2005, 7, 197–209.
V. Aiyagari, V. The clinical management of acute intracerebral hemorrhage. Expert Rev. Neurother. 2015, 15, 1421–1432.
VI. Broderick, J.P.; Brott, T.; Tomsick, T.; Huster, G.; Miller, R. The Risk of Subarachnoid and Intracerebral Hemorrhages in Blacks as Compared with Whites. N. Engl. J. Med. 1992, 326, 733–736.
VII. Dupont, S.; Wijdicks, E.; Lanzino, G.; Rabinstein, A. Aneurysmal Subarachnoid Hemorrhage: An Overview for the Practicing Neurologist. Semin. Neurol. 2010, 30, 545–554.
VIII. Lovelock, C.E.; Rinkel, G.J.E.; Rothwell, P.M. Time trends in outcome of subarachnoid hemorrhage: Population-based study and systematic review. Neurology 2010, 74, 1494–1501.
IX. Ziu, E.; Mesfin, F.B. Subarachnoid Hemorrhage. In StatPearls; StatPearls Publishing, 2021; Available online: http://www.ncbi.nlm.nih.gov/books/NBK441958/ (accessed on 22 August 2021).
X. Lagares, A.; Gómez, P.; Lobato, R.; Alén, J.; Alday, R.; González, P.; de la Lama, A.; Palomino, J.; Miranda, P.; Campollo, J. Idiopathic subarachnoid hemorrhage; comparison of different bleeding patterns and long-term outcome. Neurocirugia2002, 13, 110–119.
XI. Guglielmi, G.; Viñuela, F.; Sepetka, I.; Macellari, V. Electrothrombosis of saccular aneurysms via endovascular approach: Part 1: Electrochemical basis, technique, and experimental results. J. Neurosurg. 1991, 75, 1–7.
XII. Guglielmi, G.; Viñuela, F.; Dion, J.; Duckwiler, G. Electrothrombosis of saccular aneurysms via endovascular approach: Part 2: Preliminary clinical experience. J. Neurosurg. 1991, 75, 8–14.
XIII. Murayama, Y.; Nien, Y.L.; Duckwiler, G.; Gobin, Y.P.; Jahan, R.; Frazee, J.; Martin, N.; Viñuela, F. Guglielmi Detachable Coil embolization of cerebral aneurysms: 11 years’ experience. J. Neurosurg. 2003, 98, 959–966.
XIV. Song, J.; Lim, Y.C.; Ko, I.; Kim, J.-Y.; Kim, D.-K. Prevalence of Intracranial Aneurysms in Patients with Systemic Vessel Aneurysms. Stroke 2020, 51, 115–120.
XV. Schievink, W.I. Intracranial Aneurysms. N. Engl. J. Med. 1997, 336, 28–40.
XVI. Van Gijn, J.; Rinkel, G.J.E. Subarachnoid haemorrhage: Diagnosis, causes and management. Brain 2001, 124, 249–278.
XVII. International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured Intracranial Aneurysms—Risk of Rupture and Risks of Surgical Intervention. N. Engl. J. Med. 1998, 339, 1725–1733.
XVIII. Molyneux, A.J.; Kerr, R.S.; Yu, L.-M.; Clarke, M.; Sneade, M.; Yarnold, J.; Sandercock, P. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005, 366, 809–817.
XIX. Anxionnat, R.; Tonnelet, R.; Derelle, A.; Liao, L.; Barbier, C.; Bracard, S. Endovascular treatment of ruptured intracranial aneurysms: Indications, techniques and results. Diagn. Interv. Imaging 2015, 96, 667–675.
XX. Gallas, S.; Pasco, A.; Cottier, J.-P.; Gabrillargues, J.; Drouineau, J.; Cognard, C.; Herbreteau, D. A Multicenter Study of 705 Ruptured Intracranial Aneurysms Treated with Guglielmi Detachable Coils. Am. J. Neuroradiol. 2005, 26, 1723–1731.
XXI. Pierot, L.; Wakhloo, A.K. Endovascular Treatment of Intracranial Aneurysms: Current Status. Stroke 2013, 44, 2046–2054.