Wu Qiaowei, Ai Changsi, Bi Yuange, Yao Jinbiao, Sun Qi, Xu Shancai, Zhang Bohan, Wu Pei, Kui Yongjian, Shi Huaizhang, Wang Yuehua
Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
Department of Neurology, Hongda Hospital of Jiamusi University, Jiamusi, Heilongjiang, China.
Interv Neuroradiol. 2023 Aug 16:15910199231193904. doi: 10.1177/15910199231193904.
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.
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.
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, = 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%, > 0.99). Angiography follow-up was available for 21 patients, and complete aneurysm occlusion was observed in 16/21 (76.2%) aneurysms.
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.
大型基底动脉主干动脉瘤（BTAs）若不治疗，其自然转归较差，且一直对血管内治疗构成重大挑战。本研究旨在分析大型BTAs血管内治疗后的并发症。
这是一项回顾性观察队列研究。2015年1月至2022年9月期间，9116例颅内动脉瘤患者到我院接受治疗，其中34例大型（≥10mm）BTAs患者接受了血管内治疗。评估术后并发症、临床及血管造影结果。
34例患者（34个动脉瘤）均成功治疗，其中13个动脉瘤采用血流导向（FD）治疗，21个动脉瘤采用支架辅助弹簧圈栓塞治疗。12例（35.3%）患者发生神经并发症，7例（20.6%）死亡。10例（29.4%）患者发生缺血性并发症，4例（11.8%）患者发生出血事件。出院时和末次随访时良好预后的发生率分别为85.3%和75.8%。1年和3年的累积生存率分别为86.5%和71.4%。单侧椎动脉牺牲与术后并发症相关（风险比：3.74，95%置信区间：1.06 - 13.25, P = 0.041）。FD治疗和支架辅助弹簧圈栓塞治疗患者术后并发症发生率相当（5/13, 38.5% 对 7/21, 33.3%, P > 0.99）。21例患者进行了血管造影随访，16/21（76.2%）个动脉瘤观察到完全闭塞。
血管内治疗可能是治疗大型BTAs的一种可行选择。然而，临床医生应警惕与手术相关的并发症，尤其是导致残疾或死亡的缺血性并发症。单侧椎动脉牺牲可能与术后并发症相关。
