Endovascular treatment of basilar tip aneurysms in the era of endosaccular flow disruption: a comparative study

Abstract

Purpose This study aims to compare endosaccular flow disruptor (EFD) for treatment of basilar tip aneurysm (BTA) with coiling in terms of safety and efficacy. Methods We retrospectively reviewed patients treated with an EFD for BTAs at our institution between 2013 and 2019 to standard coiling from the same period (control group). Patient demographics, aneurysm characteristics, procedural data, complications and clinical and angiographic outcome were compared between groups. Results Twenty-three (56%) patients were treated with an EFD and eighteen (44%) patients were treated with coiling. Average aneurysm size was 8 mm in the EFD group and 6.9 mm in the coiling group, respectively (P = 0.2). Average fluoroscopy time, treatment DAP and air kerma were 33 min, 76 Gycm2 and 1.7 Gy in the EFD group and 81 min, 152 Gycm2 and 3.8 Gy in the coiling group, respectively (P < 0.001). In the EFD group, clinically relevant thromboembolic complications occurred in one patient (4%) vs. in 5 patients (28%) in the coiling group (P = 0.07). In each group, 4 patients had an unfavourable outcome at discharge (P = 0.7). Adequate occlusion rates were 96% in the EFD group and 100% and coiling group. Six (26%) patients were prescribed long-term antiplatelet therapy in the EFD group vs. eleven (61%) patients in the coiling group (P = 0.02). Conclusion Both treatment concepts provided similar technical success and safety. However, procedure time, radiation exposure and a need for long-term antiaggregation were lower with EFD.

Comparing treatment outcomes of various intracranial bifurcation aneurysms locations using the Woven EndoBridge (WEB) device

“…Re-treatment was required in 4% versus 0%, respectively. Symptomatic thromboembolic complications were encountered in 4% versus 17%, respectively 7. In our study, adequate aneurysm occlusion was achieved in 91.6% of these aneurysms with a 5.6% re-treatment rate.…”

“…These foundational trials were essential to establish the device, but none of them compared the outcomes between different locations and aneurysms were treated as one entity. To date, few studies have evaluated the treatment outcomes for individual bifurcation locations following use of the WEB device, and all have done so in considerably smaller numbers than the present study 5–7…”

“…Several studies, including the WEB-IT trial2 which led to Food and Drug Administration approval of the device, grouped all bifurcation aneurysms into one category and concluded adequate safety and efficacy of WEB embolization 2–4. However, few studies have evaluated the usefulness of the WEB device in different bifurcation aneurysms individually, and those that did were limited by small sample sizes 5–7…”

Endovascular treatment of wide-necked intracranial aneurysms using the Nautilus Intrasaccular System: initial case series of 41 patients at a single center

“…The primary advantage of the Nautilus is that it is independent of dual antiplatelet therapy, which is often helpful, particularly in ruptured aneurysms 1. Although conceptually similar, the devices have unique features and properties and may overlap in terms of being suitable for treating complex WNBAs 20. Although the spherically-shaped WEB and LUNA devices are designed to fill the aneurysm volumetrically, the Contour has no volume but adapts to the neck plane in a conical or U-shaped fashion 21.…”

“… 1 Although conceptually similar, the devices have unique features and properties and may overlap in terms of being suitable for treating complex WNBAs. 20 Although the spherically-shaped WEB and LUNA devices are designed to fill the aneurysm volumetrically, the Contour has no volume but adapts to the neck plane in a conical or U-shaped fashion. 21 Limitations with these approaches include the steep learning curve regarding control and precision of device placement, case selection, and implant sizing.…”