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

• Published in: Interdisciplinary neurosurgery : Advanced techniques and case management Vol. 8; no. C; pp. 50 - 56
• Main Authors: Tjahjadi, Mardjono, MD, Kim, Tackeun, MD, Ojar, Devendra, MD, Byoun, Hyoung Soo, MD, Lee, Si Un, MD, Ban, Seung Pil, MD, Hwang, Gyojun, MD, PhD, Kwon, O-Ki, MD, PhD
• Format: Journal Article
• Language: English
• Published: Elsevier 01.06.2017
• Subjects: Basilar tip aneurysm; Coiling; Long-term follow up; Medical Education; Neurosurgery; Stent-assisted coiling; HH; RR; MRI; Thromboembolic; DNR; PGLA; SA; Polyglycolic/polylactic acid; Long-term follow up; Dome-Neck Ratio; First segment of posterior cerebral artery; SM; MM; Glasgow Outcome Score; P1; Single Microcatheter; Stent-Assisted Coiling; Magnetic Resonance Angiography; GOS; Trans Femoral Catheter Angiography; Magnetic Resonance Imaging; TE; Basilar tip aneurysm; Hunt-Hess; WEB; Coiling; TFCA; Woven EndoBridge; Multiple Microcatheter; Raymond-Roy; MRA
• DOI: 10.1016/j.inat.2017.01.005
• ISSN: 2214-7519

Abstract 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 treatment to angiographic approach remains the long-term coil-mass durability and less patent published results regarding treatment outcome and long-term efficacy. 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 attendance. Results In our study, sac size ( p < 0.001), neck size ( p < 0.001), and ruptured status ( p < 0.001), were the determining 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' attendances. Logistic regression analyses concluded factors that were directly linked to a “major recanalization” outcome include: (i) ruptured-status ( p = 0.05), (ii) aneurysm size > 11 mm ( p < 0.001), and (iii) aneurysm neck size > 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.