Endovascular treatment on ruptured wide-neck intracranial aneurysms: Single-center retrospective study on efficacy and safety

Abstract

Objectives: The aim of this single-center retrospective study was to evaluate the efficacy and safety of endovascular treatment for ruptured intracranial wide-neck aneurysms. Material and Methods: This single-center retrospective study aims to evaluate cases of ruptured wide-neck intracranial aneurysms treated endovascularly between 2018 and 2023 at Pamela Youde Nethersole Eastern Hospital in Hong Kong. Patient demographics, aneurysmal characteristics, procedural devices used, peri-procedural complications, and post-procedural angiographic and clinical outcomes will be analyzed. The primary outcome will be the complete occlusion rate of the treated aneurysms and the incidence of peri-procedural complications. Secondary outcome will include clinical outcomes assessed using the modified Rankin scale (mRS). We hypothesize that flow diversion may represent an efficient and safe endovascular treatment option for ruptured wide-neck aneurysms. Results: The median age of patients was 60 years, with a predominance of females (74.2%). Aneurysms were commonly located in the anterior communicating artery (25.8%) and posterior communicating artery (21.2%), measuring a median size of 4.2 mm with a dome-to-neck ratio <2 in the majority (98.4%). Follow-up angiography at 6 and 12–24 months showed near-complete occlusion rates of 76.4% and 84.2%, respectively. Flow diversion exhibited significantly higher rates of complete occlusion compared to other treatments (P = 0.021 at 6 months, P = 0.049 at 12–24 months). Ischemic complications occurred, including thromboembolism in 3.0% and coil protrusion causing parent artery occlusion in 4.5% of cases, primarily during simple coiling procedures. Hemorrhagic complications, such as re-ruptured aneurysms, were noted in 12.1% of cases. Favorable clinical outcomes (mRS 0–2) were observed in 54.5%, 62.1%, and 63.6% of patients at 1, 6, and 12 months, respectively, with poorer outcomes associated with severe subarachnoid hemorrhage (SAH) and larger aneurysm size (>6 mm) (P = 0.017 for modified Fisher scale III–IV; P = 0.009 and 0.001 for large aneurysm (>6 mm) at 6 months and 12–24 months, respectively). Conclusion: We observed relatively satisfactory outcomes regarding the efficacy and safety of endovascular treatment for ruptured wide-neck intracranial aneurysms. Flow diversion with or without adjunctive coiling emerged as an effective treatment option with a high rate of aneurysmal occlusion and acceptable complication rates. Our study highlighted that large aneurysms (>6mm) and poor grades of SAH were associated with poorer clinical outcomes. These findings underscore the need for prospective studies with larger sample sizes to validate and refine our results.