Basilar Apex Aneurysm: Case Series, Systematic Review, and Meta-analysis

Dandurand, Charlotte; Prakash, Swetha; Sepehry, Amir Ali; Tourigny, Katherine; Haw, Charles S.; Gooderham, Peter; Moore, Justin M.; Redekop, Gary

doi:10.1016/j.wneu.2020.02.064

Cited by 14 publications

(11 citation statements)

References 34 publications

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“…Dandurand et al reported in a meta-analysis that stent-assisted coiling had a higher rate of complete occlusion (55% vs. 45%), lower rate of residual aneurysm (15% vs. 23%), lower rate of retreatment (17% vs. 24%) and a higher rate of post-treatment haemorrhage (5% vs. 3%) compared with coiling. 13 Our results, in comparison to previous stent-assisted coiling studies, were better with regard to the occlusion rate, morbidity and mortality. Further and more concrete comparisons between our results of wide neck aneurysms treated with multiple microcatheters and the results of other aneurysm series treated with adjunctive techniques is very challenging due to the lack of comparable data.…”

Section: Other Assisted Coiling Techniquessupporting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

“…The distal basilar artery is a challenging location for microsurgical clipping. 13 Excluding oculomotor nerve palsy, which complicates 21.4% of surgical clipping procedures, the surgical morbidity rate is as high as 19.4%. 14 Sanai et al reported in their study of 228 aneurysms (156 of the distal basilar) treated with clipping that the morbidity and mortality rates were 7.8% and 7.4%, respectively, after surgery.…”

Section: Clipping Versus Coilingmentioning

confidence: 99%

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Unassisted and multiple microcatheter coiling of distal basilar aneurysms: Outcomes and literature review

et al. 2021

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Purpose The best treatment for distal basilar artery aneurysms is controversial. We aimed to review our single-centre experience with coil embolisation of aneurysms at this location and compare it with the surgical and endovascular literature. Methods Forty-two aneurysms in a distal basilar location in 42 consecutive patients (15 ruptured and 27 unruptured) were treated endovascularly from 2010 to 2015. Unassisted single and multiple microcatheter coil embolisation alone was used in all cases. We studied our immediate and long-term anatomical results, operative complications, and outcome. Results The immediate angiographic results showed complete occlusion in 34 (81%), a neck remnant in seven (16.6%) and a residual aneurysm in one patient (2.4%). There were two thromboembolic events (4.7%) without clinical sequelae; therefore, the operative morbidity and mortality were zero. Three patients with ruptured aneurysms (7.1%) died due to complicated vasospasm. Thirty-nine patients (93%) had clinical and MR imaging follow-up (mean 32.3 months ± 18.6, range from 12 to 66 months). There was recanalization in 30.8% with a retreatment rate of 15.3% and no new bleedings. The aneurysm size was the most important predictor of early anatomical outcome and recurrence. Conclusion Unassisted and multiple microcatheter coiling is a safe treatment for distal basilar aneurysms. Early anatomical results and recurrence depend on the aneurysm size. Morbidity and mortality are lower and recurrence rates are higher in comparison with clipping or other adjunctive endovascular techniques.

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Section: Other Assisted Coiling Techniquessupporting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Section: Clipping Versus Coilingmentioning

confidence: 99%

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Unassisted and multiple microcatheter coiling of distal basilar aneurysms: Outcomes and literature review

et al. 2021

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“…Symptomatic thromboembolic complications at the basilar tip were encountered in 2.8%. Those rates are significantly better than stent-assisted coiling and flow diversion reported in other studies 6 12–14…”

Section: Discussionmentioning

confidence: 63%

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

Adeeb

Dibas

Diestro

et al. 2022

J NeuroIntervent Surg

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BackgroundThe Woven EndoBridge (WEB) device has Food and Drug Administration approval for treatment of wide-necked intracranial bifurcation aneurysms. The WEB device has been shown to result in adequate occlusion in bifurcation aneurysms overall, but its usefulness in the individual bifurcation locations has been evaluated separately only in few case series, which were limited by small sample sizes.ObjectiveTo compare angiographic and clinical outcomes after treatment of bifurcation aneurysms at various locations, including anterior communicating artery (AComA), anterior cerebral artery (ACA) bifurcation distal to AComA, basilar tip, internal carotid artery (ICA) bifurcation, and middle cerebral artery (MCA) bifurcation aneurysms using the WEB device.MethodsA retrospective cohort analysis was conducted at 22 academic institutions worldwide to compare treatment outcomes of patients with intracranial bifurcation aneurysms using the WEB device. Data include patient and aneurysm characteristics, procedural details, angiographic and functional outcomes, and complications.ResultsA total of 572 aneurysms were included. MCA (36%), AComA (35.7%), and basilar tip (18.9%) aneurysms were most common. The rate of adequate aneurysm occlusion was significantly higher for basilar tip (91.6%) and ICA bifurcation (96.7%) aneurysms and lower for ACA bifurcation (71.4%) and AComA (80.6%) aneurysms (p=0.04).ConclusionTo our knowledge, this is the most extensive study to date that compares the treatment of different intracranial bifurcation aneurysms using the WEB device. Basilar tip and ICA bifurcation aneurysms showed significantly higher rates of aneurysm occlusion than other locations.

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“…On the other hand, endovascular treatment is associated with lower rates of long-term occlusions and a higher risk of retreatment [20,21]. According to the authors of a recent meta-analysis, as far as the endovascular technique is concerned, stent-assisted coiling provides a lower risk of recurrence compared to coiling but a higher risk of posttreatment haemorrhage [22]. Among 24 basilar apex aneurysms described in our study, eight (33%) were treated with stent-assisted coiling, 12 (50%) with coiling, three (13%) with balloon-assisted coiling, and one (4%) with stenting.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of vertebrobasilar system aneurysms — long term results

Szmygin

Roman

et al. 2021

Neurol Neurochir Pol.

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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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Basilar Apex Aneurysm: Case Series, Systematic Review, and Meta-analysis

Cited by 14 publications

References 34 publications

Unassisted and multiple microcatheter coiling of distal basilar aneurysms: Outcomes and literature review

Unassisted and multiple microcatheter coiling of distal basilar aneurysms: Outcomes and literature review

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

Endovascular treatment of vertebrobasilar system aneurysms — long term results

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