Management of wide-neck aneurysms in 2024: how does one make the best treatment decision when there are so many good options?

A middle-aged patient walks into the office for the first time with an unruptured, medium sized, wide-neck middle cerebral artery (MCA) aneurysm incorporating both M2 origins into the aneurysm neck. What is the best management for this patient? What is the safest and most effective treatment option? How does one make the decision when there are so many good options currently available? Wide-neck aneurysms (WNAs) are defined as those with a neck width >4 mm, a dome to neck ratio <2, or both features.1 They may be ruptured or unruptured. These aneurysms are more challenging to treat and require more advanced techniques2 in comparison to narrow-neck aneurysms for which stand-alone coiling is often very straightforward, low risk, and effective. The treatment options in 2024 for WNAs are seemingly endless and include (but are not limited to) microsurgical (MS) clipping, balloon assisted coiling (BAC), stent assisted coiling...
Source: Journal of NeuroInterventional Surgery - Category: Neurosurgery Authors: Tags: Basic science Source Type: research