Expanding Endovascular Therapy of Very Small XXXX with the 1.5-mm Coil.

@entity1 @entity510 @entity438 @entity5034 @entity397 @entity439 @entity1756
BACKGROUND: Very small @entity1756 ( <=3 mm) demonstrate a significant risk for procedural @entity397 with endovascular therapy. Since 2007, 1.5-mm-diameter coils have been available (Micrus, Microvention, and ev3), allowing neurointerventionalists the opportunity to offer @entity1 with very small @entity439 endovascular treatment. In this study, we review the clinical and angiographic outcome of @entity1 with very small @entity1756 treated with the 1.5-mm coil. METHODS: This is a retrospective cohort study in which we examined consecutive @entity1756 treated with coil embolization at a single institution. The longest linear @entity439 was recorded, even if the first coil was sized to a smaller transverse diameter. @entity439 were defined as  <=3 mm. Descriptive results are presented. RESULTS: From July 2007 to March 2015, 81 @entity439 were treated acutely with coils in 78 @entity1 presenting with @entity510 . There were 5 @entity1 with 3-mm @entity439 , of which the transverse diameter was  <=2 mm in 3 @entity1 . In all 5 @entity1 , a balloon was placed for hemostatic prophylaxis in case of @entity397 , and a single 1.5-mm coil was inserted for @entity439 treatment without complication. Complete @entity439 was achieved in 1 @entity1 , residual neck in 2, and residual @entity439 in 2 @entity1 . @entity439 was present in 2 @entity1 with an anterior communicating @entity438 ; a recoiling attempt was unsuccessful in 1 of these 2 @entity1 due to inadvertent displacement and distal coil embolization, but subsequent surgical clipping was successful. Another @entity1 was retreated by surgical clipping for a residual wide-neck carotid terminus @entity439 . One @entity1 died of @entity5034 3 weeks after presentation; all 4 other @entity1 had an excellent outcome with no rebleed at follow-up (mean 21 months, range 1-62). CONCLUSION: The advent of the 1.5-mm coil may be used in the endovascular treatment of @entity1 with very small @entity1756 , providing a temporary protection to the site of @entity397 in the acute phase. If necessary, bridging with elective clipping may provide definitive @entity439 treatment.
