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Koji Iihara, Nobuyuki Sakai, Kenichi Murao, Hideki Sakai, Toshio Higashi, Shuji Kogure, Jun C. Takahashi, and Izumi Nagata

advocated as treatments of choice. Nevertheless, relatively benign natural histories have been reported in cases presenting with ischemic symptoms, and the indications and timings for treatment of non-SAH cases remain controversial. 13, 21, 35 Recently, the advent of endovascular surgery changed treatment options for VA dissecting aneurysms, especially during the acute phase following SAH, because this technique enables not only occlusion of the parent artery but also obliteration of the entire segment of the dissected site with coils (internal trapping) more easily in

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Koji Iihara, Kenichi Murao, Nobuyuki Sakai, Atsushi Shindo, Hideki Sakai, Toshio Higashi, Shuji Kogure, Jun C. Takahashi, Katsuhiko Hayashi, Toshihiro Ishibashi, and Izumi Nagata

placement, especially in large or giant paraclinoid aneurysms. 4, 35 Regarding endovascular surgery, the technique of using a balloon to remodel coils at the neck of the aneurysm has also made wider-neck lesions treatable with coil embolization. 1 It remains controversial whether remodeling techniques increase thromboembolic complications. 24, 27 Neck size is an independent risk factor for these complications, 34 probably because the increased surface area of exposed coils at the interface of the aneurysm and parent artery could serve as a nidus for fibrin strand and