Endovascular Therapy for Basilar Arterial Trunk Aneurysms

Wang, Yiheng; Xu, Kan; Song, Jia; Yu, Jinlu

doi:10.3389/fneur.2021.625909

Cited by 7 publications

(10 citation statements)

References 18 publications

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“…Angiographic outcome at last follow-up did not significantly differ between the groups; however, incidence of progressive occlusion was significantly higher in the FD group (62.5 vs. 5.7%; p < 0.001). Although the procedure-related complication rate in our study was high, it did not significantly differ between the FD (23.5%) and conventional stent groups (23.3%) and is in line with rates reported in other studies ( 19 , 21 ). The main risk in either group is an ischemic complication.…”

Section: Discussionsupporting

confidence: 92%

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Reconstructive Endovascular Treatment of Basilar Trunk and Vertebrobasilar Junction Aneurysms: A Review of 77 Consecutive Cases

Peng

Zhou

et al. 2022

Front. Neurol.

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BackgroundBasilar trunk and vertebrobasilar junction (BTVBJ) aneurysms have a poor prognosis and are challenging to treat.ObjectiveThis study aimed to evaluate the efficacy of reconstructive endovascular treatment for BTVBJ aneurysms and explore a treatment selection paradigm.MethodsClinical and angiographic data from 77 patients with 80 BTVBJ aneurysms who underwent endovascular treatment with flow diverters (FDs) or conventional stent-assisted coiling between January 2016 and December 2020 were retrospectively analyzed. Aneurysm characteristics and treatment outcomes were compared between treatment groups.ResultsAmong the 77 study patients, 34 (44.2%) were treated with FDs and 43 (55.8%) with conventional stent-assisted coiling. Overall, 72.7% of patients achieved favorable clinical outcome at follow-up. The rate of procedure-related complications was 23.4%. The aneurysm occlusion rate at last follow-up did not differ between the FD and conventional stent groups (79.2% vs. 77.1%, p = 0.854). Although the occlusion rate immediately after the procedure was lower in the FD group (29.4%), incidence of progressive occlusion was significantly higher (62.5 vs. 5.7%; p < 0.001). The proportion of patients with large and giant aneurysms (≥10 mm) was significantly higher in the FD group (70.6 vs. 34.8%; p = 0.002). In patients with large or giant aneurysms, favorable clinical outcome at last follow-up was achieved in 75% of patients in the FD group but only 43.8% of patients in the conventional stent group (p = 0.046). Moreover, the complication rate was lower in the FD group, but the difference was not significant (20.8 vs. 37.5%; p = 0.247). The same analyses were performed for patients with small aneurysms (<10 mm) but no significant differences between the two groups were observed.ConclusionEndovascular treatment of small BTVBJ aneurysms using either FDs or conventional stents was feasible and effective. In patients with large or giant aneurysms, treatment using FDs achieved higher rates of occlusion and favorable clinical outcome at last follow-up than conventional stent-assisted coiling.

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Section: Discussionsupporting

confidence: 92%

“…Several studies have reported unsatisfactory outcomes after EVT of BTVBJ aneurysms. Wang et al ( 19 ) reported an 82.1% favorable outcome rate in conjunction with 17.9% mortality. Another study reported a 78.6% satisfactory outcome rate ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

Reconstructive Endovascular Treatment of Basilar Trunk and Vertebrobasilar Junction Aneurysms: A Review of 77 Consecutive Cases

Peng

Zhou

et al. 2022

Front. Neurol.

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“…Only coiling of saccular aneurysms in VBD can result in a good prognosis due to providing the least hemodynamic disturbance. In our previous report, a secular aneurysm on the BA trunk with VBD achieved a good outcome after simple coiling with/without stenting assistance (47). However, for large fusiform and complex aneurysms in VBD, complex EVT, such as FDS deployment, can result in an uncertain and varied prognosis (49).…”

Section: Prognosismentioning

confidence: 95%

“…From nature, most aneurysms associated with VBD are dissecting and can present with saccular or fusiform ( 46 , 47 ). Saccular aneurysms can be treated with the same principle as used for intracranial bifurcation aneurysms ( Figure 7 ).…”

Section: Evt Prospectsmentioning

confidence: 99%

Prospects and Dilemmas of Endovascular Treatment for Vertebrobasilar Dolichoectasia

Wang¹,

Yu²

2022

Front. Neurol.

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Vertebrobasilar dolichoectasia (VBD) is characterized by significant expansion, elongation, and tortuosity of the basilar artery and vertebral artery. Certain highly selected cases of VBD can require intervention. Recent advances in endovascular treatment (EVT) have renewed hope for patients with VBD. However, which cases of VBD can benefit from EVT still needs to be determined. Currently, little is known regarding this matter. Therefore, we performed a review of the literature from a PubMed search and cataloged our experience regarding the classification and natural history of VBD and the prospects, prognosis and complications of EVT. The findings can be summarized as follows: for asymptomatic VBD, “wait and see” or medical management may be a reasonable strategy. EVT may only be effective in certain patients. For saccular aneurysms in VBD, especially ruptured aneurysms, EVT is reasonable. For fusiform aneurysms in VBD, EVT can carry high complication rates and should be recommended with caution. For stenting reconstruction in VBD, the effect is uncertain. For the future of EVT of VBD, randomized controlled trials and the development of neurointerventional products are worth pursuing, but EVT in VBD still has a long way to go.

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“…For large IFCAs, a conventional self-expandable stent assisted with coiling cannot completely obliterate IFCAs, especially those with branches arising from the aneurysmal wall (77). However, the technique is still useful for target embolization, which targets weak points or ruptured blebs by coiling assisted by conventional stents, especially for acute IFCAs located in the MCA and BA trunk (78,79).…”

Section: Targeted Embolizationmentioning

confidence: 99%

Intracranial Fusiform and Circumferential Aneurysms of the Main Trunk: Therapeutic Dilemmas and Prospects

et al. 2021

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Intracranial fusiform and circumferential aneurysms (IFCAs), especially those located on the main trunk, are uncommon and difficult to manage. Currently, literature focused on IFCAs on the main trunk of cerebral arteries is lacking. The treatment of IFCAs is still under debate. Therefore, in this review, we further explore the treatment of this complicated entity. In addition, we also present some interesting cases. Based on the literature review and our experience, we found that IFCAs are often located in the vertebrobasilar system and that ruptured or large symptomatic IFCAs are associated with increased mortality and higher rebleeding rates. The treatment strategies for IFCAs can be classified as deconstructive and reconstructive methods via open surgery and/or endovascular treatment (EVT). Currently, EVT is a popular method and the main therapeutic choice. In particular, flow diversion has revolutionized the treatment of IFCAs. Parent artery occlusion (PAO) with or without revascularization may still be considered a suitable choice. Complex IFCAs that cannot be resolved by EVT can also be treated via open surgery with or without extracranial–intracranial bypass. Targeted embolization for the weak points of IFCAs is a temporary or palliative choice that is rarely used. In summary, despite complications, both surgical treatment and EVT are effective options for appropriately selected cases. Due to the development of endovascular implants, EVT will have better prospects in the future.

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Endovascular Therapy for Basilar Arterial Trunk Aneurysms

Cited by 7 publications

References 18 publications

Reconstructive Endovascular Treatment of Basilar Trunk and Vertebrobasilar Junction Aneurysms: A Review of 77 Consecutive Cases

Reconstructive Endovascular Treatment of Basilar Trunk and Vertebrobasilar Junction Aneurysms: A Review of 77 Consecutive Cases

Prospects and Dilemmas of Endovascular Treatment for Vertebrobasilar Dolichoectasia

Intracranial Fusiform and Circumferential Aneurysms of the Main Trunk: Therapeutic Dilemmas and Prospects

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