There are many unresolved questions in relation to endovascular therapy. Whilst GDC coiling, even partial, undoubtedly prevents re-bleeding in the short term, in the long term, efficacy is not yet known, particularly the long-term rebleeding rate. At best, the late recurrence is converted into an unruptured aneurysm. There is further controversy as recent papers [12,21] suggest that the rupture rate of an unruptured aneurysm is low and treatment unjustified.

Complete obliteration is observed in 50-80% of aneurysms with endovascular treatment. After surgery, complete occlusion is observed in 94% of aneurysms [22]. The risk of hemorrhage from incompletely occluded, surgically treated aneurysms is thought to be less than 1% per year.

The mechanisms of occlusion of an aneurysm by clipping and by coiling are obviously different. In a clipped aneurysm rest, the walls are closely apposed and the remaining aneurysm is completely excluded from the circulation [22]. In contrast, using the endovascular technique, the walls are kept apart by the coils, allowing blood to flow into the sac. In the long term, remnants lead to recurrence. Malesh [15] followed up 100 patients who underwent embolization of 104 aneurysms. Mid-term outcome was obtained for 94 patients (2-6 years, average 3.5 years). Twenty patients required further non-GDC procedures (clipping in 9, parent artery sacrifice in 11).

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