Endovascular treatment of multiple intracranial aneurysms in patients with subarachnoid hemorrhage: one or multiple sessions?

Guangjian Zhang; Weiwei Zhang; Hanxiao Chang; Yuqi Shen; Chencheng Ma; Lei Mao; Zheng Li; Hua Lu

doi:10.3389/fneur.2023.1196725

Endovascular treatment of multiple intracranial aneurysms in patients with subarachnoid hemorrhage: one or multiple sessions?

Front Neurol. 2023 Jun 20:14:1196725. doi: 10.3389/fneur.2023.1196725. eCollection 2023.

Authors

Guangjian Zhang^#^{1

2}, Weiwei Zhang^#³, Hanxiao Chang^{1

2}, Yuqi Shen^{1

2}, Chencheng Ma^{1

2}, Lei Mao^{1

2}, Zheng Li^{1

2}, Hua Lu^{1

2}

Affiliations

¹ Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
² Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China.
³ Department of Ophthalmology, Third Medical Center of Chinese PLA General Hospital, Beijing, China.

^# Contributed equally.

Abstract

Objective: This study aimed to compare the safety and efficacy of single- and multiple-stage endovascular treatment in aneurysmal subarachnoid hemorrhage (SAH) patients with multiple intracranial aneurysms.

Methods: We retrospectively analyzed the clinical and imaging data of 61 patients who harbored multiple aneurysms and presented to our institution with aneurysmal subarachnoid hemorrhage. Patients were grouped according to endovascular treatment strategy: one-stage or multiple-stage.

Result: The 61 study patients harbored 136 aneurysms. One aneurysm in each patient had ruptured. In the one-stage treatment group, all 66 aneurysms in 31 patients were treated in one session. The mean follow-up was 25.8 months (range, 12-47). At the last follow-up, the modified Rankin scale was ≤2 in 27 patients. In total, 10 complications occurred (cerebral vasospasm, six patients; cerebral hemorrhage, two patients; and thromboembolism, two patients). In the multiple-stage treatment group, only the ruptured aneurysm (30 in total) was treated at the time of presentation, and the remaining aneurysms (40 in total) were treated later. The mean follow-up was 26.3 months (range, 7-49). At the last follow-up, the modified Rankin scale score was ≤2 in 28 patients. In total, five complications occurred (cerebral vasospasm, four patients; and subarachnoid hemorrhage, one patient). During the follow-up period, there was one recurrence of aneurysm with subarachnoid hemorrhage in the single-stage treatment group and four recurrences in the multiple-stage treatment group.

Conclusion: Both single- and multiple-stage endovascular treatment is safe and effective in aneurysmal subarachnoid hemorrhage patients who harbor multiple aneurysms. However, multiple-stage treatment is associated with a lower rate of hemorrhagic and ischemic complications.

Keywords: endovascular treatment; multiple aneurysms; one-stage group; staged group; subarachnoid hemorrhage.

Grants and funding

This study was supported by grants from the Postgraduate Research and Practice Innovation Program of Jiangsu Province (No. JX10213876) and Jiangsu Province Capability Improvement Project through Science, Technology, and Education (ZDXK202225).