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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

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Ryota Kurogi, Akiko Kada, Kuniaki Ogasawara, Takanari Kitazono, Nobuyuki Sakai, Yoichiro Hashimoto, Yoshiaki Shiokawa, Shigeru Miyachi, Yuji Matsumaru, Toru Iwama, Teiji Tominaga, Daisuke Onozuka, Ataru Nishimura, Koichi Arimura, Ai Kurogi, Nice Ren, Akihito Hagihara, Yuriko Nakaoku, Hajime Arai, Susumu Miyamoto, Kunihiro Nishimura, and Koji Iihara

, 20 Interestingly, the proportion of comatose clipped patients in hospitals with higher CSC capabilities (Q3 and Q4) was relatively higher in this study. Improvements in neurosurgical techniques, such as intraoperative angiography, neurocritical care, and neuroimaging, have allowed neurosurgeons to successfully care for patients who would have previously been considered too sick to treat. The availability of technically trained surgeons and access to facilities with endovascular surgery can also sway prognosis since these institutional factors often dictate