Abstract
PurposeThis study aims to compare endosaccular flow disruptor (EFD) for treatment of basilar tip aneurysm (BTA) with coiling in terms of safety and efficacy.MethodsWe retrospectively reviewed patients treated with an EFD for BTAs at our institution between 2013 and 2019 to standard coiling from the same period (control group). Patient demographics, aneurysm characteristics, procedural data, complications and clinical and angiographic outcome were compared between groups.ResultsTwenty-three (56%) patients were treated with an EFD and eighteen (44%) patients were treated with coiling. Average aneurysm size was 8 mm in the EFD group and 6.9 mm in the coiling group, respectively (P = 0.2). Average fluoroscopy time, treatment DAP and air kerma were 33 min, 76 Gycm2 and 1.7 Gy in the EFD group and 81 min, 152 Gycm2 and 3.8 Gy in the coiling group, respectively (P < 0.001). In the EFD group, clinically relevant thromboembolic complications occurred in one patient (4%) vs. in 5 patients (28%) in the coiling group (P = 0.07). In each group, 4 patients had an unfavourable outcome at discharge (P = 0.7). Adequate occlusion rates were 96% in the EFD group and 100% and coiling group. Six (26%) patients were prescribed long-term antiplatelet therapy in the EFD group vs. eleven (61%) patients in the coiling group (P = 0.02).ConclusionBoth treatment concepts provided similar technical success and safety. However, procedure time, radiation exposure and a need for long-term antiaggregation were lower with EFD.
Highlights
Endovascular occlusion is the treatment of choice for basilar tip aneurysm (BTA)
The Woven EndoBridge (WEB; Microvention/Terumo, Aliso Viejo, CA, USA) is deployed completely endosaccular in order to reduce the inflow into the aneurysm at the level of the neck, leading to thrombus formation and potentially shrinkage of the aneurysm sac
All SAHs were grade 4 according to the Fisher scale
Summary
Endovascular occlusion is the treatment of choice for basilar tip aneurysm (BTA). the anatomy of the basilar apex and the often broad-based configuration of BTAs may make treatment challenging.A variety of different techniques has been developed to enable safe and successful endovascular treatment of bifurcation aneurysms including balloon and stent assistance in various configurations and recently developed neck-bridgingThe Woven EndoBridge (WEB; Microvention/Terumo, Aliso Viejo, CA, USA) is deployed completely endosaccular in order to reduce the inflow into the aneurysm at the level of the neck, leading to thrombus formation and potentially shrinkage of the aneurysm sac. Endovascular occlusion is the treatment of choice for basilar tip aneurysm (BTA). The anatomy of the basilar apex and the often broad-based configuration of BTAs may make treatment challenging. A variety of different techniques has been developed to enable safe and successful endovascular treatment of bifurcation aneurysms including balloon and stent assistance in various configurations and recently developed neck-bridging. The Woven EndoBridge (WEB; Microvention/Terumo, Aliso Viejo, CA, USA) is deployed completely endosaccular in order to reduce the inflow into the aneurysm at the level of the neck, leading to thrombus formation and potentially shrinkage of the aneurysm sac. The Contour device (Cerus Endovascular, Fremont, CA, USA) was introduced; similar to WEB, it is designed to disrupt the inflow into the aneurysm sac at the level of the neck of the aneurysm. Once optimally deployed at the aneurysm neck, it adopts a conical shape, covering the lower part of the aneurysm and the neck [8, 9]
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