Abstract
BackgroundTreatment of perforator involving aneurysm (piAN) remains a challenge to open and endovascular neurosurgeons. Our aim is to demonstrate a primary outcome of endovascular therapy for piANs with the use of perforator preservation technologies (PPT) based on a new neuro-interventional classification.MethodsThe piANs were classified into type I: aneurysm really arises from perforating artery, type II: saccular aneurysm involves perforating arteries arising from its neck (IIa) or dome (IIb), and type III: fusiform aneurysm involves perforating artery. Stent protection technology of PPT was applied in type I and III aneurysms, and coil-basket protection technology in type II aneurysms. An immediate outcome of aneurysmal obliteration after treatment was evaluated (satisfactory obliteration: the saccular aneurysm body is densely embolized (I), leaving a gap in the neck (IIa) or dome (IIb) where the perforating artery arising; fusiform aneurysm is repaired and has a smooth inner wall), and successful perforating artery preservation was defined as keeping the good antegrade flow of those perforators on postoperative angiography. The periprocedural complication was closely monitored, and clinical and angiographic follow-ups were performed.ResultsSix consecutive piANs (2 ruptured and 4 unruptured; 1 type I, 2 type IIa, 2 type IIb, and 1 type III) in 6 patients (aged from 43 to 66 years; 3 males) underwent endovascular therapy between November 2017 and July 2019. The immediate angiography after treatment showed 6 aneurysms obtained satisfactory obliteration, and all of their perforating arteries were successfully preserved. During clinical follow-up of 13–50 months, no ischemic or hemorrhagic event of the brain occurred in the 6 patients, but has one who developed ischemic event in the territory of involving perforators 4 h after operation and completely resolved within 24 h. Follow-up angiography at 3 to 10M showed patency of the parent artery and perforating arteries of treated aneurysms, with no aneurysmal recurrence.ConclusionsOur perforator preservation technologies on the basis of the new neuro-interventional classification seem feasible, safe, and effective in protecting involved perforators while occluding aneurysm.
Highlights
Treatment of perforator involving aneurysm remains a challenge to open and endovascular neurosurgeons
Satti et al proposed a three-point classification based on the exact anatomical origin of basilar artery perforator aneurysms (BAPAs) and present this unique classification system to enable future papers to standardize descriptions: type I—the aneurysm arises from the basilar trunk adjacent to the perforating arterial branch but not involving a perforating artery; type IIa— aneurysms incorporating the origin of the perforating arteries; type IIb—aneurysms having the perforating artery arising from the dome of the aneurysm; and type III—fusiform aneurysms arising beyond the parent vessel [3, 4]
We improved the classification method based on the characteristics and feasibility of interventional therapy and proposed some perforator preservation technologies (PPT) on basis of this classification, which can protect the blood supply of the perforator artery on the premise of ensuring the satisfactory aneurysm packing
Summary
Treatment of perforator involving aneurysm (piAN) remains a challenge to open and endovascular neurosurgeons. Satti et al proposed a three-point classification based on the exact anatomical origin of basilar artery perforator aneurysms (BAPAs) and present this unique classification system to enable future papers to standardize descriptions: type I—the aneurysm arises from the basilar trunk adjacent to the perforating arterial branch but not involving a perforating artery; type IIa— aneurysms incorporating the origin of the perforating arteries; type IIb—aneurysms having the perforating artery arising from the dome of the aneurysm; and type III—fusiform aneurysms arising beyond the parent vessel (basilar artery) [3, 4] This classification method is only applicable to BAPAs, not completely applicable to all intracranial piANs. We improved the classification method based on the characteristics and feasibility of interventional therapy and proposed some perforator preservation technologies (PPT) on basis of this classification, which can protect the blood supply of the perforator artery on the premise of ensuring the satisfactory aneurysm packing.
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