Bi Yuange, Tian Yangyang, Chi Yunbo, Chen Xiaohan, Song Xiaopeng, Chen Xuan, Yang Zhongxi, Zhou Jing
Department of Neurosurgery, First Hospital of Jilin University, Changchun, China.
Department of Radiotherapy, Third Hospital of Jilin University, Changchun, China.
Front Neurol. 2025 Aug 29;16:1628676. doi: 10.3389/fneur.2025.1628676. eCollection 2025.
Basilar trunk aneurysms (BTAs) are rare and challenging to treat, with a high complication rate. This study aimed to analyze and evaluate the complications and long-term outcomes associated with endovascular treatment (EVT) of BTAs and identify risk factors for post-procedural complications and unfavorable clinical outcomes.
This retrospective, observational cohort study included 90 patients (92 BTAs) treated with EVTs from January 2011 to April 2023. Factors associated with post-procedural complications and unfavorable clinical outcomes were analyzed.
All 90 patients (92 aneurysms) were successfully treated, of which 63 (68.5%) aneurysms were small, 26 (28.3%) were large, and 3 (3.3%) were giant; 23 (25%) were saccular, and 69 (75%) were fusiform and/or dissecting. A total of 36 (40.0%) patients were admitted with ruptured aneurysm. The median follow-up duration was 51.0 months (IQR 21.0-3.0). The favorable clinical outcome rate was 75.6% (68/90). The overall complication rate was 33.33% (30/90), with ischemic and hemorrhagic complications occurring in 25.6% (23/90) and 2.2% (2/90) of cases, respectively. The mortality rate was 8.9% (8/90). Unilateral vertebral artery sacrifice ( = 0.015), Glasgow Coma Scale (GCS) grade ≤12 before the procedure ( < 0.047), and age ≥60 years ( = 0.006) were associated with overall post-procedural complications. Diabetes mellitus ( = 0.002), ischemic onset ( = 0.005), aneurysms involving the vertebrobasilar junction ( = 0.025), and GCS grade ≤12 before the procedure ( < 0.001) were risk factors for unfavorable clinical outcomes. Cumulative survival rates at 1, 3, and 5 years were 95.4%, 92.1%, and 87.9%, respectively. The cumulative complication-free survival rates were 72.1%, 68.3%, and 64.5%, respectively. Angiographic follow-up revealed complete occlusion in 71.7% (33/46).
EVT for BTAs appears feasible and yields favorable clinical outcomes at the last follow-up, with reasonable cumulative survival rates at 1, 3, and 5 years. However, clinicians should be vigilant for procedure-related complications, particularly ischemic complications, which may lead to poor outcomes or death.
基底动脉干动脉瘤（BTAs）较为罕见，治疗具有挑战性，并发症发生率高。本研究旨在分析和评估BTAs血管内治疗（EVT）相关的并发症和长期预后，并确定术后并发症及不良临床结局的危险因素。
本回顾性观察队列研究纳入了2011年1月至2023年4月接受EVT治疗的90例患者（92个BTAs）。分析了与术后并发症和不良临床结局相关的因素。
所有90例患者（92个动脉瘤）均成功治疗，其中63个（68.5%）动脉瘤为小型，26个（28.3%）为大型，3个（3.3%）为巨大型；23个（25%）为囊状，69个（75%）为梭形和/或夹层型。共有36例（40.0%）患者因动脉瘤破裂入院。中位随访时间为51.0个月（四分位间距21.0 - 3.0）。良好临床结局率为75.6%（68/90）。总并发症发生率为33.33%（30/90），缺血性和出血性并发症分别发生在25.6%（23/90）和2.2%（2/90）的病例中。死亡率为8.9%（8/90）。单侧椎动脉牺牲（P = 0.015）、术前格拉斯哥昏迷量表（GCS）评分≤12分（P < 0.047）和年龄≥60岁（P = 0.006）与术后总体并发症相关。糖尿病（P = 0.002）、缺血性起病（P = 0.005）、累及椎基底动脉交界处的动脉瘤（P = 0.025）和术前GCS评分≤12分（P < 0.XXX）是不良临床结局 的危险因素。1年、3年和5年的累积生存率分别为95.4%、92.1%和87.9%。累积无并发症生存率分别为72.1%、68.3%和64.5%。血管造影随访显示71.7%（33/46）完全闭塞。
BTAs的EVT似乎可行，末次随访时临床结局良好，1年、3年和5年累积生存率合理。然而，临床医生应警惕与手术相关的并发症，尤其是缺血性并发症，其可能导致不良结局或死亡。 （注：原文中“< 0.001”处XXX可能有误，这里保留原文格式）
