Cerebral Aneurysms: Therapeutic Strategies

• DOI: https://doi.org/10.22533/at.ed.15953225221013

• Palavras-chave: Intracranial Aneurysm; Endovascular Therapy; Microsurgical Clipping; Flow Diverters; Coil Embolization; Subarachnoid Hemorrhage; Neurointervention.

• Keywords: Intracranial Aneurysm; Endovascular Therapy; Microsurgical Clipping; Flow Diverters; Coil Embolization; Subarachnoid Hemorrhage; Neurointervention.

• Abstract:

  Intracranial aneurysms (IAs) are arterial dilations whose rupture causes subarachnoid hemorrhage, an event with high morbidity and mortality. Treatment aims to exclude the aneurysm from circulation while preserving the parent vessel. This narrative review addresses the main therapeutic strategies, divided into two categories: microsurgery and endovascular therapy. Microsurgical clipping, the conventional method, offers high rates of durable occlusion but is more invasive. Endovascular therapy, which has become the first line of treatment in many centers, has evolved exponentially. It began with platinum coil embolization (coiling), which was improved by balloon-assisted techniques and stents to treat wide-neck aneurysms. A paradigm shift occurred with flow diverters, which reconstruct the parent artery, and intrasacculary flow disruptors (such as the WEB device), which induce thrombosis within the aneurysmal sac. Recent innovations include specialized stents for bifurcations (PulseRider) and the introduction of robotics in neurointervention, which promises greater precision and safety. The choice of therapeutic modality is complex, individualized, and depends on the characteristics of the aneurysm, the patient, and the experience of the team.