Endovascular Management of Vertebrobasilar Trunk Artery Large Aneurysms: Complications and Long-Term Results

Abstract

ObjectiveTo analyze the complications and long-term results of endovascular management of vertebrobasilar trunk large (≥10 mm) aneurysms (VBTLAs) and identify predictors of outcomes.MethodsBetween 2014 and 2020, 6,987 patients with intracranial aneurysms were referred to our center for aneurysm management and 2,224 patients have undergone the endovascular procedures. We retrospectively reviewed the database and identify all the patients with VBTLAs.ResultsA total of 62 VBTLAs were identified. The median aneurysm size was 13.4 mm [interquartile range (IQR) 11.5–18.7]. Among them, 24 aneurysms were treated with overlapping stent techniques, 18 aneurysms were treated with flow diversion, 14 aneurysms were treated with single stent-assisted coiling, and 6 aneurysms were treated with coiling alone. Ten patients were treated with parent artery occlusion or unilateral vertebral artery occlusion. Periprocedural complications were occurred in 7 (11.3%) patients. Clinical follow-up was obtained at the median of 27.5 months (IQR 15.3–58.5). The overall complication rate was 16.1% (10/62), including nine ischemic events and one hemorrhagic event. The combined disability and neurological mortality rate was 12.9% (8/62), with 4 (6.5%) deaths. The favorable outcome rate at follow-up was 87.1% (54/62). The complication-free cumulative survival rates at 1 and 5 years were 86.8 and 82.0%, respectively. The overall cumulative survival rates at 1 and 5 year were 96.5 and 89.8%, respectively. In the multivariate Cox regression analysis, longer procedure time (>115 min) (P = 0.037) and ischemic onset (P = 0.005) predict complications. Angiography follow-up was available for 36 patients at the median of 6.0 months (IQR 6–12), with a complete occlusion rate of 77.8% (28/36). Two (5.6%) aneurysms were recanalized and subsequently received the retreatment. Subgroup analysis did not find any differences in the complete occlusion rate between endovascular strategies.ConclusionEndovascular management of VBTLAs has a reasonable safety profile with favorable 5-year cumulative survival rates and imaging outcomes at follow-up. Prolonged procedure and ischemic onset are associated with a high risk of overall complications.

Reconstructive endovascular treatment for basilar artery trunk aneurysms: complications and clinical and angiography outcomes

“…Ischemic onset has been reported as a predictor of cerebral ischemic complications 6. In this study, asymptomatic BTAs tended to be associated with a lower rate of procedural ischemic and hemorrhagic complications.…”

“…These may be incidental findings or present with subarachnoid hemorrhage (SAH), mass compression of surrounding structures, or ischemic stroke induced by perforating artery occlusion, resulting in high morbidity and mortality 1 3–5. BTAs gradually increase in size and pose a higher risk of rupture than anterior circulation aneurysms 1 3 4 6. Therefore, aggressive therapies should be considered for patients with symptomatic BTAs.…”

“…Deconstructive EVT techniques (such as parent artery occlusion) are effective and have a higher occlusion rate for BTAs, but may cause severe neurologic complications due to insufficient collateral circulation after the parent vessel has been sacrificed 2. Reconstructive EVT techniques (simple coils, conventional stents with or without coils, and the stent-in-stent technique) may be more suitable for BTAs but are associated with substantial morbidity and mortality and a higher recurrence rate during follow-up 6 7. Flow diversion is an attractive treatment for BTAs, but it is controversial and off-label 8.…”

“…To date, few studies have evaluated the efficacy and safety of reconstructive EVT for BTAs. Previous studies often included small sample sizes, and several studies included both basilar and vertebral artery aneurysms,6 9 the latter of which can differ from BTAs in terms of endovascular complications and disease outcomes 5. Further studies are needed to evaluate the efficacy and safety of reconstructive EVT for BTAs.…”

Low-profile visualized intraluminal support-within-Enterprise overlapping-stent technique versus flow diversion in the treatment of intracranial vertebrobasilar trunk dissecting aneurysms

“…In a meta-analysis of patients treated with FD for posterior circulation nonsaccular aneurysms, Kiyofuji et al (9) reported that the overall mortality and morbidity rates were 21% and 26%, respectively, and another meta-analysis reported that the periprocedural complication rates of patients with nonsaccular posterior circulation were 6% after stentassisted coiling, and 18% after FD treatment (5). It has also been reported that ischemic events account for most complications after the endovascular treatment of VBTDAs (29,30). Taken together, our findings show that during the endovascular treatment of VBTDAs, it is necessary to pay attention to the occurrence of postoperative complications, especially ischemic events.…”