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Vol. 34. Issue 4.
Pages 168-176 (July - August 2023)
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Vol. 34. Issue 4.
Pages 168-176 (July - August 2023)
Clinical Research
Endovascular treatment of posterior circulation aneurysms: Results from a single-team experience of 81 cases including 13 flow diversion treatment
Tratamiento endovascular de aneurismas de circulación posterior: resultados de una experiencia de 81 casos realizada por un solo equipo, incluyendo 13 tratamientos de desviación de flujo
Ilyas Dolasa, Tugrul Cem Unala, Cafer Ikbal Gulsevera,
Corresponding author
cafer.gulsever@gmail.com

Corresponding author.
, Duran Sahina, Heydar Huseynovb, Mehmet Barburogluc, Onur Ozturkd, Halil Cane, Ali Ekrem Adiyamana, Huseyin Emre Dagdevirena, Pulat Akin Sabancia, Aydin Aydoselia, Yavuz Arasa, Altay Sencera, Serra Sencerc
a Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
b Department of Radiology, Istanbul Atlas University, Istanbul, Turkey
c Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
d Department of Neurosurgery, Istanbul Bilim University, Istanbul, Turkey
e Department of Neurosurgery, Istanbul Atlas University, Istanbul, Turkey
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Figures (1)
Tables (5)
Table 1. Summary of demographics, clinical presentation, aneurysm characteristics and treatment method.
Table 2. Admission WFNS grades of SAH patients.
Table 3. Summary of demographics, clinical presentation, aneurysm location-size, treatment method, angiographic findings at the immediate and follow-up DSAs, final clinical outcomes, short and long term complications of the patients whom treated with flow diverting effect.
Table 4. Immediate postoperative and follow-up aneurysm occlusion rates in primer coiling, balloon and stent-assisted coiling group (1 patient died after unsuccessful treatment attempt and 3 patients with SAH died in the early post-treatment period due to complications associated with SAH. Mortality rate was 5.9%).
Table 5. Complications and their management. Last mRS were noted in the follow-up period.
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Abstract
Introduction

Relatively constant surgical risks and rapid advances in endovascular treatment have caused a major shift toward endovascular management of posterior circulation aneurysms. This paper presents the results of a series of endovascularly treated posterior circulation aneurysms.

Methods

A total of 81 patients who underwent endovascular treatment of posterior circulation aneurysms performed by a single team between 2009 and 2019 were included. Demographic, clinical, radiologic, and management details were retrospectively obtained from hospital records.

Results

Among the included patients, 50 (61.7%) and 31 (38.3%) were female and male, respectively. Subarachnoid hemorrhage was observed in 30 patients (37%). Moreover, 40 (49.3%) aneurysms were treated with stent-assisted coiling, 1 (1.2%) aneurysm was treated with parent artery occlusion, 2 (2.4%) aneurysms were coiled using balloon assistance, 24 (29.6%) aneurysms were coiled primarily, 1 (1.2%) patient had an unsuccessful treatment attempt, and 13 (16.0%) aneurysms were treated with flow-diverter stents or stent monotherapy. During the last follow-up, 57 (83.8%) aneurysms were completely occluded, whereas 6 (8.8%) and 2 (2.9%) aneurysms did and did not have a residual neck, respectively. Flow diversion was used to treat 13 patients, among whom 8 had total occlusion or stable residue. A total of 7 deaths (8.6%) were encountered in this series.

Conclusion

Endovascular treatment should be considered as the primary treatment modality for posterior circulation aneurysms. Despite the high morbidity and mortality rates, promising results can be achieved with correct patient selection. Flow diversion can be a feasible alternative for complex aneurysms that are difficult to treat.

Keywords:
Aneurysm
Subarachnoid hemorrhage
Posterior circulation
Endovascular
Stent
Resumen
Introducción

Los riesgos quirúrgicos relativamente constantes y los rápidos avances en el tratamiento endovascular han provocado un viraje importante a dar preferencia al tratamiento endovascular en los aneurismas de la circulación posterior. Este artículo presenta los resultados de una serie de aneurismas de la circulación posterior tratados endovascularmente.

Métodos

Se incluyeron un total de 81 pacientes que fueron sometidos a tratamiento endovascular de aneurismas de la circulación posterior realizado por un solo equipo entre 2009 y 2019. Los detalles demográficos, clínicos, radiológicos y de manejo del paciente se obtuvieron retrospectivamente de los registros hospitalarios.

Resultados

Entre los pacientes incluidos, 50 (61,7%) eran mujeres y 31 (38,3%) eran hombres. Se observó hemorragia subaracnoidea en 30 de los pacientes (37%). Además, 40 (49,3%) de las aneurismas se trataron con enrollamiento asistido por stent, 1 (1,2%) aneurisma se trató con oclusión de la arteria madre, 2 (2,4%) aneurismas se enrollaron con asistencia de balón, 24 (29,6%) aneurismas se enrollaron en espiral, 1 (1,2%) paciente tuvo fallo en el intento del tratamiento y 13 (16,0%) aneurismas fueron tratados con stents desviadores de flujo o con monoterapia de stents. Durante el último seguimiento, 57 (83,8%) aneurismas estaban completamente ocluidos, mientras que 6 (8,8%) y 2 (2,9%) aneurismas tenían y no tenían cuello residual, respectivamente. La derivación de flujo se utilizó para tratar a 13 pacientes, de los cuales 8 tenían oclusión total o presentaban residuo estable. En esta serie se contabilizaron un total de 7 muertes (8,6%).

Conclusión

El tratamiento endovascular debería considerarse como la modalidad de tratamiento principal para los aneurismas de la circulación posterior. A pesar de las altas tasas de morbilidad y de mortalidad, se pueden lograr resultados prometedores con una correcta selección de los pacientes. La desviación del flujo puede ser una buena alternativa para los aneurismas complejos de difícil tratamiento.

Palabras clave:
Aneurisma
Hemorragia subaracnoidea
Circulación posterior
Stent

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