Abstract
Background and Purpose: Endovascular coiling is widely used for treatment of both ruptured and unruptured aneurysms. Intracranial bifurcation aneurysms were classically considered unsuitable for endovascular treatment because of the risk of coil protrusion into the parent vessel. The introduction stent assisted coiling has allowed the bifurcation aneurysms to be endovascularly treated. The present study aims to evaluate the efficacy of the endovascular treatment of the intracranial bifurcation aneurysms. Methods: This study was conducted on 76 patients with radiologically documented intracranial aneurysms at bifurcation sites either ruptured (12 aneurysms) or unruptured (64 aneurysms). Endovascular coiling of intracranial aneurysms was done for all patients in our study aided in some with single or Y-configuration stenting. The radiological outcome was assessed immediately postoperative, and at follow-up at 6 and 12 month with grading of the angiograms on the basis of modified 3-point Raymond scale. Results: In terms of the Raymond grading (RG), the initial angiographic outcome was complete occlusion (RG1) in 45 aneurysms (59.2%), neck remnant (RG2) in 20 aneurysms (26.3%), and body filling (RG3) in 11 aneurysms (14.5%), while the final angiographic outcome at 1 year was RG1 in 55 aneurysms (72.4%), RG2 in 13 aneurysms (17.1%), and RG3 in 8 aneurysms (10.5%). Eleven aneurysms (14.5%) showed recanalization. The aneurysm size and the neck width were the statistically significant factors affecting the initial RG (P = 0.0005, 0.001 respectively), final RG (P = 0.015, 0.012 respectively), and the recanalization rate (P = 0.012, 0.01 respectively). Conclusions: Endovascular treatment of intracranial aneurysms at bifurcation sites is safe and effective. Stent assisted coiling (SAC) has enabled us to offer a safe and effective endovascular treatment for bifurcation aneurysms by preventing coils herniation. Smaller aneurysm size and neck size are indicators of complete occlusion and lower recanalization rate.
Highlights
Intracranial bifurcation aneurysms were classically considered unsuitable for endovascular treatment because of the risk of coil protrusion into the parent vessel
The present study aims to evaluate the efficacy of the endovascular treatment of the intracranial bifurcation aneurysms
Intracranial aneurysm tends to occur at regions of sharp vessel curvature, and bifurcations such as the basilar bifurcation, the internal carotid artery (ICA) bifurcation, the middle cerebral artery (MCA) bifurcation, and the anterior communicating artery
Summary
Intracranial aneurysm tends to occur at regions of sharp vessel curvature, and bifurcations such as the basilar bifurcation, the internal carotid artery (ICA) bifurcation, the middle cerebral artery (MCA) bifurcation, and the anterior communicating artery. The reason for this is unknown, but the heterogeneous distribution suggests the presence of local contributing factors such as high wall shear stress, turbulence, and other hemodynamic forces implicated in its pathogenesis [1]. Intracranial bifurcation aneurysms were classically considered unsuitable for endovascular treatment because of the risk of coil protrusion into the parent vessel. Smaller aneurysm size and neck size are indicators of complete occlusion and lower recanalization rate
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