Long-term review of selected basilar-tip aneurysm endovascular techniques in a single institution

2/8/2019 12:00:00 AM

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Authors: Mardjono Tjahjadi, Tackeun Kim, Devendra Ojar, Hyoung Soo Byoun, Si Un Lee, Seung Pil Ban, Gyojun Hwang, O-Ki Kwon

Publication date: 9 January 2017.

Interdisciplinary Neurosurgery

Volume: 8, Pages 50-56

Link:https://reader.elsevier.com/reader/sd/pii/S2214751916301426?token=E54D37A7BA23F4313741F0913750C8CEEFC6EF4DAEA79298904D5F157612A295EA27640A991886D3A06E91566578B4C9

 

 

A b s t r a c t  

Background: Several endovascular techniques and devices are presently available for the non-surgical treatment of basilar-tip aneurysms in dedicated neurovascular departments. However, the  revolving drawback to treat- ment to angiographic approach remains the long-term coil-mass durability and less patent published results re- garding treatment outcome and long-term ef?cacy. We aim  to share our  experience of selected endovascular techniques for treating basilar-tip aneurysms and  its long-term clinical and angiographic outcome.

Material and  methods: We retrospectively reviewed 109  patients basilar-tip aneurysm who had endovascular treatment in  our  department  from 2003 to  2014. Three groups were based on  treatment method: single microcatheter (SM),  multiple microcatheters (MM), and stent-assisted (SA) coiling techniques. All procedural- related complications and outcomes were followed and analyzed. Angiographic follow-up with accompanying skull-series review were evaluated from initial coil-mass occlusion time to the last  follow-up outpatient atten- dance.

Results: In our  study, sac size (p b 0.001), neck size (p b 0.001), and ruptured status (p b 0.001), were the deter- mining factors of endovascular techniques selection in treating basilar-tip aneurysm. Technique selection was validated as clinically and angiographically effective over a mean 43.5 month follow-up in 90% of outpatients’ at- tendances. Logistic  regression analyses concluded factors that were directly linked to a “major recanalization” outcome include: (i) ruptured-status (p = 0.05), (ii)  aneurysm size  N 11 mm (p b 0.001), and (iii)  aneurysm neck size N 4 mm (p = 0.006).

Conclusion: Small  aneurysms particularly those with a small-neck size can be treated with SM or MM approach. Medium-large sized aneurysm can be treated effectively by combined MM and SA techniques.

 

Keywords: Basilar tip aneurysm, Coiling, Stent-assisted coiling, Long-term follow up