Do we still need coils for the endovascular treatment of intracranial aneurysms?

Controlled-detachable coils (Guglielmi detachable coils) were introduced in 1991 as part of the armamentarium of tools available for aneurysm endovascular treatment. The value of these coils compared with clipping has been confirmed by the International Subarachnoid Aneurysm Trial (ISAT), one of the most important studies in the field of intracranial aneurysm treatment.1 2 However, one important limitation of aneurysm coiling was rapidly identified: difficulty in treating wide-neck aneurysms. Moret et al proposed the remodeling technique (balloon-assisted coiling) for the treatment of wide-neck aneurysms followed by progressive introduction of stent-assisted coiling.3 4 These two techniques placed coils in the aneurysm using additional balloons and stents to maintain the coils there. An additional limitation of aneurysm coiling was subsequently identified—namely, the relatively high risk of aneurysm recanalization. The French study, ARETA (Analysis of Recanalization after Endovascular Treatment), will permit us to analyze the patient, aneurysm, and treatment factors that affect aneurysm recanalization.5 …