Curative effect of endovascular techniques on aneurysms associated with intracranial severe stenosis

Abstract

Objective To evaluate the curative effect of endovascular techniques on aneurysms associated with intracranial severe stenosis. Methods Twenty-six patients with aneurysms associated with intracranial severe stenosis, admitted to our hospital from July 2009 to July 2015, were treated with endovascular techniques. The aneurysms were typed according to the morphology and pathway (type I and II). Different endovascular interventional therapy strategies (a subtype and b subtype) were selected according to the typing. Results Of the 26 patients, 10 were treated with selective coil occlusion of the aneurysm, one with double microcatheter, one with balloon-coil embolization and 14 with stent-coil embolization. Procedural rupture occurred in one aneurysm mainly caused by the balloon dilation, leading to death. Five patients were the Ia subtype, selective coil occlusion of the aneurysm was adopted in the 4 patients and stent-coil embolization in one, enjoying the results that 4 were completely occluded and one was sub-totally occluded. Five patients were the Ib subtype, selective coil occlusion of the aneurysm was adopted in the 4 patients and stent-coil embolization in one, enjoying the results that two were completely occluded, one was sub-totally occluded, and two were incomplete embolization. Nine patients were the IIa subtype, selective coil occlusion of the aneurysm was adopted in one patient, double microcatheter in one patient, and stent-coil embolization in seven, enjoying the results that three were completely occluded, three was sub-totally occluded, and the other three were incomplete embolization. Seven patients were the IIb subtype, selective coil occlusion of the aneurysm was adopted in one patient, balloon-coil embolization in one patient, and stent-coil embolization in five, enjoying the results that one were completely occluded, one was sub-totally occluded, and the other five were incomplete embolization. One patient died at the balloon-coil embolization, one patient treated with stent-coil embolization developed thrombosis infarction, and one appeared procedural rupture with delayed vasospasm but without permanent disability. The mean follow-up time was 26±11 months, with modified Rankin Scale scores 0-2 in 20 patients, 3 in 4 patients and 6 in 2 patients. Conclusions Treatment of aneurysms associated with intracranial severe stenosis is challenging for endovascular treatment. It is effective and safe to select appropriate endovascular interventional therapy according to the typing of aneurysms. Key words: Aneurysm; Intracranial stenosis; Endovascular treatment; Stent-coil embolization