New endovascular approaches in management of intracranial complex bifurcation aneurysms not amenable to simple coiling

Abstract

Background: Aneurysmal neck remodeling with stents has recently emerged as an effective treatment option. Flow-diverter devices (FDDs), Silk flow diverter stent, the Woven EndoBridge (WEB) have been proven to be a valuable tool in the endovascular treatment of wide-necked bifurcation aneurysms. Aim: The purpose of this study was to assess the efficacy, safety and durability of new endovascular approaches in management of intracranial complex bifurcation aneurysms. Subjects and Methods: Between October 2017 and august 2019, we performed 37 endovascular procedures for 32 patients having intracranial complex bifurcation aneurysms. The procedures were performed in the “Vascular and Interventional Unit” of the Radiology Department, in Kasr-Al Ainy Hospital, and Sheikh Zayed specialized Hospital. Results: One out of 30 patients (3.3%) had a procedural related complication, which was a femoral puncture and scrotal hematoma. Two days later this patient died from MI, and this was the only mortality in our study. Eight out of 30 patients (26.6 %) still experienced mild degrees of morbidity and neurological deficits related to the natural history of the SAH and unrelated to the procedures. One out of 10 patients (10%) treated by balloon assisted coiling showed neck recanalization at 6 months angiographic follow up.