Treatment of Partially Thrombosed Intracranial Aneurysms: Single-Center Series and Systematic Review

Abstract

Partially thrombosed intracranial aneurysms (PTIAs) represent a challenging subgroup of aneurysms, with an organized intraluminal thrombus and a solid mass, in which the optimal therapeutic strategy is discussed controversially because of limited data. We therefore analyzed the results of surgical and endovascular treatment in patients with PTIAs treated in our department and combined the results with a systematic literature review. Between January 2006 and October 2016, data from 996 patients with intracranial aneurysms were prospectively entered into a database. Twenty-five consecutive patients harbored PTIAs and were treated in the authors' institution. The degree of aneurysm occlusion, the degree of recurrence, and the necessity of aneurysm retreatment were assessed and analyzed. PubMed was searched for published studies of PTIAs to gain a larger population. Multivariate regression models were performed on the pooled data. Literature data, including the present series, revealed a total of 157 patients. Overall, 64 patients (41%) were treated by clipping, and 93 patients (59%) were treated by endovascular treatment. In the multivariate analysis, surgical treatment of PTIAs was an independent predictor for complete aneurysm occlusion (P < 0.001). In a second multivariate model, endovascular treatment was independently associated with aneurysm recurrence (P<0.001). In a third multivariate model, endovascular treatment was associated with a higher rate of retreatment (P < 0.001). In this study, surgical treatment of PTIAs showed superior initial radiologic results and better long-term stability than endovascular treatment. Therefore, surgical treatment should be considered in those patients harboring PTIAs who are qualified as suitable surgical candidates after interdisciplinary consensus.