Stent, balloon, or clip? The problem of wide-necked aneurysms [Stent, ballon oder clip? Das problem der breitbasigen aneurysmen]

The treatment of intracranial aneurysms has increasingly been taken over by the endovascular approach. However, wide-necked aneurysms represent a technical limitation since coils may prolapse into the parent vessel, potentially causing vessel occlusion. Meanwhile, new techniques are available to treat these aneurysms which were not amenable to the interventional treatment some years ago. Several techniques and materials have been developed to occlude the wide neck of an aneurysm transiently or permanently and accordingly allow or support embolization of the aneurysm. The remodeling technique prevents coil protrusion by transient and complete occlusion of the parent artery. Moreover, this technique also molds the coils inside the aneurysm allowing for a filling also in irregularly shaped aneurysms. In principle, aneurysm treatment with Onyx resembles closely this treatment approach except that a liquid embolic agent is used. A permanent coverage of the orifice of the aneurysm is achieved by detachable systems like TriSpan and, in particular, stents. This review article outlines the up-to-date standard of techniques and systems available in the treatment of wide-necked aneurysms, which increasingly become treatable by the endovascular approach. There is a great potential for future developments to further improve the interventional treatment of wide-necked aneurysms. © Urban & Vogel.