Department of Neurosurgery, First Hospital of Jilin University, Changchun, China.
J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107957. doi: 10.1016/j.jstrokecerebrovasdis.2024.107957. Epub 2024 Aug 18.
Treatment of ruptured basilar artery trunk (BAT) aneurysms is challenging, and is associated with high complication and mortality rates. Herein, we analyzed the complications, long-term outcomes, and outcome predictors of endovascular treatment for ruptured BAT aneurysms.
Between January 2011 and July 2023, 36 patients with 36 ruptured BAT aneurysms underwent endovascular treatment at our institution. The postprocedural complications and clinical and angiographic outcomes were subsequently reviewed, and the risk factors for postprocedural complications were evaluated.
All 36 aneurysms in 36 patients were treated successfully. The median clinical follow-up time was 47.0 (IQR: 10.5, 84.5) months. Overall, complications occurred in 10 (27.8%) patients, including 3 (8.3%) deaths. Ischemic events occurred in seven (19.4%) patients, while three (8.3%) patients had shunt-dependent hydrocephalus, of whom one (2.8%) patient had both shunt-dependent hydrocephalus and ischemic events. The cumulative survival rates at 3 and 5 years were 94.1% and 87.8%, respectively. The cumulative 3- and 5-year complication-free survival rates were 75.0% and 70.0%, respectively. Multivariate Cox regression analysis revealed that diabetes mellitus (HR:8.76, 95%CI:2.35-32.69, p=0.001), and Glasgow coma scale score ≤ 12 before the procedure (HR:5.04, 95%CI:1.40-18.12, p=0.013) were associated with overall postprocedural complications. The complete aneurysm occlusion rate was 61.5% at a median angiography follow-up time of 6.0 (IQR: 5.0, 6.0) months.
Endovascular treatment is a safe and feasible option for treating ruptured BAT aneurysms. The rate of favorable outcomes at the final follow-up was satisfactory. However, postprocedural complications, particularly ischemic events, should be carefully considered.
治疗破裂的基底动脉干（BAT）动脉瘤具有挑战性，并且与高并发症和死亡率相关。在此，我们分析了血管内治疗破裂 BAT 动脉瘤的并发症、长期结果和预后预测因素。
2011 年 1 月至 2023 年 7 月，我院对 36 例 36 个破裂的 BAT 动脉瘤患者进行了血管内治疗。随后回顾了术后并发症和临床及血管造影结果，并评估了术后并发症的危险因素。
36 例患者的 36 个动脉瘤均成功治疗。中位临床随访时间为 47.0（IQR：10.5，84.5）个月。总体而言，10 例（27.8%）患者发生并发症，包括 3 例（8.3%）死亡。7 例（19.4%）患者发生缺血性事件，3 例（8.3%）患者发生分流依赖性脑积水，其中 1 例（2.8%）患者同时发生分流依赖性脑积水和缺血性事件。3 年和 5 年的累积生存率分别为 94.1%和 87.8%。3 年和 5 年无并发症的累积生存率分别为 75.0%和 70.0%。多变量 Cox 回归分析显示，糖尿病（HR：8.76，95%CI：2.35-32.69，p=0.001）和术前格拉斯哥昏迷量表评分≤12（HR：5.04，95%CI：1.40-18.12，p=0.013）与总体术后并发症相关。中位血管造影随访时间为 6.0（IQR：5.0，6.0）个月时，完全动脉瘤闭塞率为 61.5%。
血管内治疗是治疗破裂 BAT 动脉瘤的一种安全且可行的选择。最终随访时的良好结局率令人满意。然而，术后并发症，特别是缺血性事件，应仔细考虑。
