Complications after endovascular treatment of large basilar trunk aneurysms

Qiaowei Wu; Changsi Ai; Yuange Bi; Jinbiao Yao; Qi Sun; Shancai Xu; Bohan Zhang; Pei Wu; Yongjian Kui; Huaizhang Shi; Yuehua Wang

doi:10.1177/15910199231193904

Complications after endovascular treatment of large basilar trunk aneurysms

Interv Neuroradiol. 2023 Aug 16:15910199231193904. doi: 10.1177/15910199231193904. Online ahead of print.

Authors

Qiaowei Wu¹, Changsi Ai², Yuange Bi³, Jinbiao Yao¹, Qi Sun¹, Shancai Xu¹, Bohan Zhang¹, Pei Wu¹, Yongjian Kui¹, Huaizhang Shi¹, Yuehua Wang⁴

Affiliations

¹ Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
² Department of Neurology, Hongda Hospital of Jiamusi University, Jiamusi, Heilongjiang, China.
³ Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China.
⁴ Department of Neurosurgery, Shanghai Seventh People's Hospital, Shanghai, China.

PMID: 37586704
DOI: 10.1177/15910199231193904

Abstract

Background and purpose: Large basilar trunk aneurysms (BTAs) have a poor natural history if left untreated and always pose a significant challenge to endovascular treatment. The present study aimed to analyze the complications after endovascular treatment of large BTAs.

Methods: This was a retrospective, observational, cohort study. Between January 2015 and September 2022, 9116 patients with intracranial aneurysms came to our institution for management, of which 34 patients with 34 large (≥10 mm) BTAs were treated with endovascular treatment. Postprocedural complications, clinical, and angiographic outcomes were evaluated.

Results: All 34 patients (34 aneurysms) were successfully treated, of which 13 aneurysms were treated with flow diversion (FD), and 21 aneurysms were treated with stent-assisted coiling. Neurological complications occurred in 12 (35.3%) patients, with 7 (20.6%) deaths. Ischemic complications occurred in 10 (29.4%) patients, and 4 (11.8%) patients experienced hemorrhagic events. The incidences of favorable outcomes at discharge and last follow-up were 85.3% and 75.8%, respectively. The cumulative survival rates at 1 and 3 years were 86.5% and 71.4%, respectively. Unilateral vertebral artery sacrifice was associated with postprocedural complications (hazard ratio: 3.74, 95% confidence interval: 1.06-13.25, p = 0.041). The postprocedural complication rates were comparable between patients treated with FD and stent-assisted coiling (5/13, 38.5% vs. 7/21, 33.3%, p > 0.99). Angiography follow-up was available for 21 patients, and complete aneurysm occlusion was observed in 16/21 (76.2%) aneurysms.

Conclusions: Endovascular treatment might be a feasible option for treating large BTAs. However, clinicians should be alerted to procedure-related complications, especially ischemic complications that cause disability or death. Unilateral vertebral artery sacrifice might be associated with postprocedural complications.

Keywords: Flow diversion; basilar artery; endovascular treatment; intracranial aneurysm; stent-assisted coiling.