Vol 55, No 6 (2021)
Research Paper
Published online: 2021-10-27

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Endovascular treatment of vertebrobasilar system aneurysms — long term results

Paweł Szmygin1, Maciej Szmygin2, Tomasz Roman2, Tomasz Jargiełło2
Pubmed: 34704602
Neurol Neurochir Pol 2021;55(6):567-573.


Introduction: Microsurgical treatment of VBSA is complex and challenging due to the deep location of the vessels and the proximity of important structures. Therefore, minimally invasive endovascular techniques have been introduced to the treatment of VBSA. The aim of this study was to present long-term results and technical aspects of VBSA embolisation. In this manuscript, we describe our experience in the treatment of VBSA with long-term results. Furthermore, we discuss the advantages and disadvantages of this treatment modality, paying special attention to the technical aspects. We believe that this is an important contribution to this topic because the number of previous reports is limited. It adds to a population that can be compared to patients treated using different methods.

Materials and methods: We analysed the medical records of patients with aneurysms of vertebral and basilar arteries referred for endovascular treatment between 2015 and 2020.

Results: A total of 44 patients were selected for the study. From this group, 10 patients (22.7%) were admitted with SAH caused by ruptured VBSA. The median age of the patients was 58 years (31-80), with 27 (61.4%) females and 17 (38.6%) males. The majority of the VBSAs (35, 79.5%) were located on the basilar artery. Complete occlusion was achieved in 39 patients (88.6%). Procedural complications occurred in three cases (6.8%). In long-term follow-up, complete embolisation was achieved in 81.8% (36 of 44 patients). In 18.2% (eight patients), recurrence of VBSA was observed. Two patients were qualified for recoiling. Clinical follow-up was uneventful in 37 (84%) patients. Four patients (9%) reported mild headaches. Three (7%) patients required assistance for daily living.

Conclusions: Endovascular embolisation of VBSA is feasible and provides an excellent rate of complete occlusion and a high rate of favourable long-term outcomes, which support using this technique as a first-line treatment. A relatively high rate of recurrence remains the major drawback, especially in cases of wide-neck VBSA.

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  1. Piccinin MA, Munakomi S. Neuroanatomy, Vertebrobasilar System. StatPearls Publishing 2021.
  2. Kim DJ, Heo Y, Byun J, et al. Role of microsurgery for treatment of posterior circulation aneurysms in the endovascular era. J Cerebrovasc Endovasc Neurosurg. 2020; 22(3): 141–155.
  3. Keedy A. An overview of intracranial aneurysms. Mcgill J Med. 2006; 9(2): 141–146.
  4. Cianfoni A, Pravatà E, De Blasi R, et al. Clinical presentation of cerebral aneurysms. Eur J Radiol. 2013; 82(10): 1618–1622.
  5. Rinkel GJ, Djibuti M, Algra A, et al. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke. 1998; 29(1): 251–256.
  6. Wermer MJH, van der Schaaf IC, Algra A, et al. Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: an updated meta-analysis. Stroke. 2007; 38(4): 1404–1410.
  7. Gruber DP, Zimmerman GA, Tomsick TA, et al. A comparison between endovascular and surgical management of basilar artery apex aneurysms. J Neurosurg. 1999; 90(5): 868–874.
  8. Pandey AS, Koebbe C, Rosenwasser RH, et al. Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: review of a 10-year experience. Neurosurgery. 2007; 60(4): 626–36; discussion 636.
  9. Zhao J, Wang S, Yang L, et al. Clinical experience of 153 patients with posterior circulation aneurysms. J Clin Neurosci. 2005; 12(1): 17–20.
  10. Bonneville F, Sourour N, Biondi A. Intracranial aneurysms: an overview. Neuroimaging Clin N Am. 2006; 16(3): 371–82, vii.
  11. Lempert TE, Malek AM, Halbach VV, et al. Endovascular treatment of ruptured posterior circulation cerebral aneurysms. Clinical and angiographic outcomes. Stroke. 2000; 31(1): 100–110.
  12. Molyneux A, Kerr R, Yu LM, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. The Lancet. 2005; 366(9488): 809–817.
  13. Wiebers D. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. The Lancet. 2003; 362(9378): 103–110.
  14. Lozier AP, Connolly ES, Lavine SD, et al. Guglielmi detachable coil embolization of posterior circulation aneurysms: a systematic review of the literature. Stroke. 2002; 33(10): 2509–2518.
  15. Toth G, Cerejo R. Intracranial aneurysms: Review of current science and management. Vasc Med. 2018; 23(3): 276–288.
  16. Shi X, Qian H, Singh KC, et al. Surgical management of vertebral and basilar artery aneurysms: a single center experience in 41 patients. Acta Neurochir (Wien). 2013; 155(6): 1087–1093.
  17. Nastasovic T, Milakovic B, Stosic M, et al. Predictors of unfavourable outcome in aneurysmal subarachnoid haemorrhage. Neurol Neurochir Pol. 2019; 53(6): 421–427.
  18. Samson D, Batjer HH, Kopitnik TA. Current results of the surgical management of aneurysms of the basilar apex. Neurosurgery. 1999; 44(4): 697–702; discussion 702.
  19. Tjahjadi M, Kivelev J, Serrone JC, et al. Factors determining surgical approaches to basilar bifurcation aneurysms and its surgical outcomes. Neurosurgery. 2016; 78(2): 181–191.
  20. Sekhar LN, Tariq F, Morton RP, et al. Basilar tip aneurysms: a microsurgical and endovascular contemporary series of 100 patients. Neurosurgery. 2013; 72(2): 284–98; discussion 298.
  21. van Eijck M, Bechan RS, Sluzewski M, et al. Clinical and imaging follow-up of patients with coiled basilar tip aneurysms up to 20 years. AJNR Am J Neuroradiol. 2015; 36(11): 2108–2113.
  22. Dandurand C, Prakash S, Sepehry AA, et al. Basilar apex aneurysm: case series, systematic review, and meta-analysis. World Neurosurg. 2020; 138: e183–e190.
  23. Ge H, Lv X, Jin H, et al. The role of endovascular treatment in unruptured basilar tip aneurysms. Interv Neuroradiol. 2017; 23(1): 8–13.
  24. Saliou G, Sacho RH, Power S, et al. Natural history and management of basilar trunk artery aneurysms. Stroke. 2015; 46(4): 948–953.
  25. Ringer AJ, Lanzino G, Veznedaroglu E, et al. Does angiographic surveillance pose a risk in the management of coiled intracranial aneurysms? A multicenter study of 2243 patients. Neurosurgery. 2008; 63(5): 845–9; discussion 849.
  26. Hendricks BK, Yoon JS, Yaeger K, et al. Wide-neck aneurysms: systematic review of the neurosurgical literature with a focus on definition and clinical implications. J Neurosurg. 2019 [Epub ahead of print]: 1–7.
  27. Lindgren AE, Koivisto T, Björkman J, et al. Irregular shape of intracranial aneurysm indicates rupture risk irrespective of size in a population-based cohort. Stroke. 2016; 47(5): 1219–1226.
  28. Ogilvy CS, Hoh BL, Singer RJ, et al. Clinical and radiographic outcome in the management of posterior circulation aneurysms by use of direct surgical or endovascular techniques. Neurosurgery. 2002; 51(1): 14–21; discussion 21.
  29. Hirashima Y, Kurimoto M, Hori E, et al. Lower incidence of symptomatic vasospasm after subarachnoid hemorrhage owing to ruptured vertebrobasilar aneurysms. Neurosurgery. 2005; 57(6): 1110–6; discussion 1110.
  30. Abdihalim M, Kim SH, Maud A, et al. Short- and intermediate-term angiographic and clinical outcomes of patients with various grades of coil protrusions following embolization of intracranial aneurysms. AJNR Am J Neuroradiol. 2011; 32(8): 1392–1398.
  31. Ishihara H, Ishihara S, Niimi J, et al. Risk factors for coil protrusion into the parent artery and associated thrombo-embolic events following unruptured cerebral aneurysm embolization. Interv Neuroradiol. 2015; 21(2): 178–183.
  32. Raymond J, Guilbert F, Weill A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003; 34(6): 1398–1403.
  33. Tamatani S, Ito Y, Abe H, et al. Evaluation of the stability of intracranial aneurysms occluded with guglielmi detachable coils. Interv Neuroradiol. 2001; 7(Suppl 1): 143–148.
  34. Lecler A, Raymond J, Rodriguez-Régent C, et al. Intracranial aneurysms: recurrences more than 10 years after endovascular treatment-a prospective cohort study, systematic review, and meta-analysis. Radiology. 2015; 277(1): 173–180.
  35. Tomalski W, Knap D, Żak A, et al. Recanalisation of cerebral artery aneurysms treated endovascularly - a midterm follow-up. Neurol Neurochir Pol. 2020; 54(6): 524–530.