Treatment Of Basilar Tip Aneurysm Research Articles

Safety and effects of endovascular treatment of basilar tip aneurysms in patients with moyamoya diseases.

The effect and safety of endovascular treatment of basilar tip aneurysms associated with moyamoya disease are unknown. This study was to investigate the safety and effect of endovascular treatment of basilar tip aneurysms associated with moyamoya disease. Patients with moyamoya disease concurrent with basilar tip aneurysms were retrospectively enrolled and treated with endovascular embolization. The clinical and angiographic data were analyzed. Thirty patients with a basilar tip aneurysm were enrolled, including 8 (26.67%) male and 22 (73.33%) female patients aged 38 to 72 years (mean 54.4 ± 8.15). Endovascular treatment was successfully performed in 29 (96.67%) patients but failed in 1 (3.33%). Immediately after embolization, aneurysm occlusion degree was Raymond-Roy grade I in 26 (89.66%), grade II in 2 (6.90%), and grade III in 1 (3.45%). Intraprocedural complications occurred in 2 (10%) patients, including aneurysm rupture in 1 (3.33%), leading to death of the patient, and stent thrombosis in 2 (6.67%) which was successfully treated with thrombolysis. At discharge, good clinical outcome (modified Rankin Scale 0-2) was achieved in 29 (96.67%) and death in 1 (3.03%). Follow-up was performed 6 to 26 months (median 15) in 27 (93.1%) patients. Aneurysm occlusion degree was Raymond-Roy grade I in 21 (77.78%) patients, grade II in 4 (14.81%), and grade III in 2 (7.41%), not significantly (P = .67) different from those immediately after embolization. Aneurysm recurrence was found in 4 patients (14.81%). The clinical outcome was modified Rankin Scale 0 to 2 in all 27 patients, not significantly different from that at discharge. Endovascular embolization can be performed safely and effectively for basilar tip aneurysms associated with moyamoya disease even though more advanced embolization techniques are necessary.

Comparison of angiographic outcomes and complication rates of WEB embolization and coiling for treatment of unruptured basilar tip aneurysms

Endovascular coiling represents the standard treatment for basilar tip aneurysms. Some of these aneurysms are not amenable to conventional coiling due to a complex aneurysm geometry, hence, novel devices such as the Woven Endobridge (WEB) have been developed. We retrospectively compared WEB embolization and coiling for the treatment of unruptured basilar tip aneurysms. Patients treated with WEB or coiling at four centers were reviewed. Procedure-related complications, clinical outcome and angiographic results were retrospectively evaluated and compared. Forty patients treated with the WEB and 35 patients treated by coiling were included. Stent-assistance was more often necessary for coiling than for WEB embolization (71% vs 2.5%, p < 0.001). The technical success rates were 100% for both methods. The overall complication rates were not significantly different between groups (WEB: 5%, coil: 11%, p = 0.409). Procedural morbidity rates were 9% in the coiling group and 2.5% in the WEB group (p = 0.334). There was no mortality. Treatment duration was shorter for WEB implantation than for coiling (p = 0.048). At mid-term follow-up, complete occlusion, neck remnants and aneurysm remnants were observed in 89%, 4% and 7% for the WEB, respectively, and in 100%, 0% and 0% for coiling. While complication rates and mid-term angiographic outcome was comparable between the groups, the WEB was associated with a shorter treatment duration and required stent-assistance less frequently. The choice of the treatment modality should be made based on the specific aneurysm characteristics, the individual experience of the neurointerventionalist and patient preference.

Long-Term Durability and Recurrence Patterns After Endovascular Treatment for Basilar Tip Aneurysms

Treating recurrence after coil embolization of basilar tip aneurysm remains challenging even with the development of endovascular procedures. The present study evaluated long-term durability and recurrence patterns after endovascular treatment of basilar tip aneurysms. Data of 116 consecutive patients treated with endovascular therapy at 3 regional hospitals from 2002-2019 were retrospectively analyzed. Aneurysms were ruptured in 51 cases and unruptured in 65 cases, with a mean maximal diameter of 7.8mm (>15mm in 14 patients) and a mean follow-up period of 5.8±4.3years. Recurrence was observed in 24 of the 116 patients (21%), and 14 patients were retreated. The 5-year recurrence-free survival rate was 75.3%. Cox proportional hazards analysis found that recurrence correlated significantly with maximal aneurysm diameter >10mm (P=0.001; hazard ratio: 3.95, 95% confidence interval: 1.76-8.90) and incomplete occlusion (P=0.003; hazard ratio: 4.43, 95% confidence interval: 1.63-12.00). Recurrence pattern was classified into 3 types: neck type (9 patients), regrowth type (10 patients), and regrowth type of initially thrombosed aneurysms (3 patients). Rerupture occurred in neck type with de novo aneurysm formation adjacent to the neck (n= 3) and regrowth type with dome filling (n= 4). Recurrence after coil embolization for basilar tip aneurysms is associated with large aneurysms and incomplete occlusion at initial embolization. Understanding the patterns of recurrence is useful for predicting recurrence and selecting treatment strategies.

Endovascular treatment of basilar tip aneurysms in the era of endosaccular flow disruption: a comparative study

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.

Clinical outcomes and cost-effectiveness analysis for the treatment of basilar tip aneurysms

BackgroundEndovascular treatment of basilar tip aneurysms is less invasive than microsurgical clipping, but requires closer follow-up.ObjectiveTo characterize the additional costs associated with endovascular treatment of basilar tip aneurysms rather than...

Microsurgical treatment of basilar tip aneurysms: is it still acceptable?

Basilar tip aneurysms (BTAs) have a complex anatomy, making them difficult to treat. We describe our surgical results for BTAs. From 2004 to 2015 (12 years), a total of 25 small BTAs and two giant BTAs were treated in the Hospital do Servidor Público Estadual de São Paulo. In 23 patients harboring aneurysms positioned anteriorly or straight, all aneurysms were clipped (complete exclusion in all on follow-up angiography). In two patients with posteriorly positioned aneurysms, there was residual neck. All patients submitted to surgical treatment of small aneurysms presented with late Glasgow Outcome Scale scores of 4 or 5. Two patients with giant aneurysms died. Surgical treatment of these lesions may be accomplished with quite high success rates and low morbidity.

Technical nuances of subtemporal approach for the treatment of basilar tip aneurysm.

Background:Basilar tip aneurysms are one of the most complex vascular lesions to treat surgically because of their location, depth of the approach, and close proximity of vital neurovascular structures such as the mesencephalon, cranial nerves, perforating arteries to the thalamus. There are different surgical approaches utilized to reach basilar tip aneurysms, namely, pterional, pretemporal, orbitozygomatic, subtemporal, and anterior petrosectomy. Each of them has its advantages and limitations.Methods:In this paper, we present our personal experience with the use of subtemporal approach. The technique is described in detail including its nuances and potential pitfalls.Results:The subtemporal approach is indicated for basilar tip aneurysms located at the level of the floor of the sella turcica to 1 cm above the dorsum sellae.Conclusion:Subtemporal approach offers good surgical corridor for the management of these complex vascular lesions.

脳底動脈先端部動脈瘤に対するY ステント支援下コイル塞栓術の経験

脳底動脈先端部動脈瘤に対するY ステント支援下コイル塞栓術の経験

Endovascular Treatment of Ruptured Large or Wide-Neck Basilar Tip Aneurysms Associated with Moyamoya Disease Using the Stent-Assisted Coil Technique

Endovascular coiling is preferred to surgical clipping for the treatment of basilar tip aneurysms (BTAs) associated with moyamoya disease (MMD). However, there are few reports addressing the safety of stent treatment of aneurysms located on unaffected arteries in MMD patients. We report our experiences of stent-assisted coil embolization for ruptured large or wide-neck BTAs associated with MMD. A retrospective review was conducted of 5 patients with ruptured BTAs associated with MMD treated by stent-assisted coil from January 2010 to December 2013 in our hospital. All presented with subarachnoid hemorrhage, and the diagnosis was confirmed by digital subtraction angiography. The procedure-related complications, immediate angiographic results, and clinical and angiographic follow-ups were analyzed. Successful embolization was performed without procedure-related complications in all 5 patients, of whom 3 were treated by single stent-assisted coiling, and the others were treated by Y-configured stent technique. Immediate angiographic results showed complete occlusion in 2 patients, neck residual in 1, and partial occlusion in 2. Postoperative angiographic follow-ups were obtained in all 5 cases at a mean time of 17.6 ± 9.3 months (range, 6-28 months). Follow-up angiographic examinations demonstrated total occlusion without in-stent restenosis in all cases, and all the patients reported good outcomes (modified Rankin Scale score, 0-2). Endovascular embolization using stent-assisted coiling proved to be a safe and efficient treatment for ruptured large or wide-neck BTAs associated with MMD; however, the long-term safety still remains to be confirmed.

Endovascular treatment for basilar tip aneurysms associated with moyamoya disease

Objective To assess the safety and efficacy of endovascular treatment for basilar tip aneurysms associated with moyamoya disease.Methods Seven patients with basilar tip aneurysms associated with moyamoya disease were treated by endovascular embolization in our department between Oct.2006 and Jul.2013.Two patients were treated by pure coiling and the others were treated by stent-assisted coiling.The immediate angiographic result was evaluated by Raymond scale.Postoperative angiographic and clinical follow-ups were obtained in all the 7cases,and the clinical outcomes were evaluated by the modified Rankin score(mRS).Results All the 7 patients successfully received endovascular embolization without procedure-related complications.Immediate angiographic results showed complete occlusion in 3cases,neck residual in 2,and partial occlusion in 2.Postoperative angiographic follow-ups were obtained for a mean of(10.4±3.5)months,with complete occlusion found in 6patients and stable in 1patient.No progressive thrombosis or in-stent occlusion were detected by follow-up angiograms in the stent group.Clinical follow-ups were obtained for a mean of(21.1±15.8)months and all the patients reported good outcomes(mRS 0-2).Conclusion Our data suggest that endovascular embolization is a safe and efficient treatment for basilar tip aneurysms associated with moyamoya disease.Stent-assistance might be a safe and effective option for the large or wide-necked aneurysms,though the long-term safety still remains to be confirmed.

Treatment strategies for aneurysms associated with moyamoya disease.

The treatment of aneurysms associated with moyamoya disease (MMD) is difficult for neurosurgeons, and little is known of strategy options. This report constitutes a comprehensive review of the literature. We summarize the known treatments and their clinical outcomes according to the site of the aneurysm: in major arteries, peripheral arteries, moyamoya vessels, meningeal arteries, or at the site of anastomosis. The literature review indicates that the treatment of MMD-associated aneurysms varies according to the site of the aneurysm and its hemodynamic characteristics. In particular, the treatment for basilar tip aneurysms remains challenging, since both endovascular embolization and direct clipping are difficult. The potential risk for ischemia should be considered in selecting endovascular or surgical approaches. Revascularization surgery, which is important for the treatment of MMD, also determines the clinical treatment outcome of aneurysms associated with MMD.

Y stenting assisted coiling using a new low profile visible intraluminal support device for wide necked basilar tip aneurysms: a technical report

Many endovascular techniques have been described in recent years for the management of wide necked aneurysms. The Y stent assisted technique has been generally used for coil embolization of wide...

Basilar Tip Aneurysms

Endovascular therapy has largely replaced microsurgical clipping for the treatment of basilar tip aneurysms. We describe the variables our center evaluates when choosing to clip or coil basilar tip aneurysms and our outcomes. Four case illustrations are presented. All patients with ruptured or unruptured basilar tip aneurysms from 2005 to April 2012 were examined. The patients were treated by 2 interventional neuroradiologists and 2 dually trained neurosurgeons. There were 63 ruptured (clipped 38%, coiled 62%) and 37 unruptured (clipped 35%, coiled 65%) aneurysms in this 100-patient study. Seventy percent of the patients with ruptured aneurysms and 92% of the patients with unruptured aneurysms had a good outcome (modified Rankin scale 0-2) at 3 months. For ruptured aneurysms, there was a statistically significant difference in clipping and coiling with respect to age and treatment modality (clip 48.8 years, coil 57.6 years). Patients in the coiled group had higher dome-to-neck (1.3 vs 1.1) (P = .01) and aspect ratios (1.6 vs 1.2) (P = .007). In the ruptured coiling group, 69.5% achieved a Raymond 1 radiographic outcome, 28% Raymond 2, and 2.5% Raymond 3. Eleven (17.4%) patients required re-treatment, and 3 (4.4%) patients were re-treated more than twice. Coiling of unruptured aneurysms resulted in 75% Raymond 1. There were no residual lesions for unruptured clipped aneurysms. There were no differences in outcome between clipping and coiling in the ruptured and unruptured group. In our current management of basilar tip aneurysms, the majority can be treated via endovascular means, albeit with the expectation of a higher percentage of residual lesions and recurrences. Microsurgery is still appropriate for aneurysms with complex neck morphologies and in young patients desiring a more durable treatment.

Safety and Efficacy of Endovascular Treatment of Basilar Tip Aneurysms by Coiling With and Without Stent Assistance

Endovascular therapy is now the preferred treatment option for basilar tip aneurysms (BTAs). To compare the safety and efficacy of common endovascular techniques in the treatment of BTAs. A retrospective review was conducted of 235 patients with BTAs treated with endovascular means in our institution between 2004 and 2011. Categorization was based on the presence and type of stent assistance (none, single, and Y stenting). The rates of perioperative complications, recanalization, rehemorrhage, and retreatment were analyzed. A total of 147 patients were treated with coil embolization and 88 patients with stent-assisted coiling (72 single stents, 16 Y stents). Thromboembolic complications occurred in 6.8% of patients in both groups. There was no associated mortality. Angiographic follow-up (mean, 23.5 months) was available in 172 patients (77.1%). Stented patients had significantly lower recanalization (17.2% vs 38.9%; P=.003) and retreatment (7.8% vs 27.8%; P=.002) rates compared with nonstented patients. Four rehemorrhages (2.7%) occurred in the coiled group, whereas none were noted in the stented group (P=.3). In paired comparisons, lower recanalization (8.3% vs 19.2%; P=.21) and retreatment (0% vs 9.6%; P=.19) rates were seen in the Y-stent group compared with the single-stent group. Thromboembolic complications occurred in 6.9% and 6.2% of patients in the single-stent and Y-stent groups, respectively (P=.91). In multivariate analysis, larger aneurysms, nonstented aneurysms, incomplete initial occlusion, and subarachnoid hemorrhage were predictors of aneurysm recanalization. Stent-assisted coiling has significantly lower recurrence, retreatment, and rehemorrhage rates than coiling alone for the treatment of BTAs. Y stenting has the highest efficacy with low complication rates.

Treatment of basilar tip aneurysms with horizontal PCA to PCA stent-assisted coiling: case series

Backgroun and objectiveCoiling of wide-necked basilar tip aneurysms is technically challenging and is often assisted by the placement of a stent. Stent placement in an anterograde fashion either with a...

Nonoverlapping Y-Configuration Stenting Technique With Dual Closed-Cell Stents in Wide-Neck Basilar Tip Aneurysms

Stent-assisted coiling is increasingly used to treat wide-neck intracranial aneurysms to protect the lumen of the parent artery from coil protrusion. This technique is insufficient for treating some aneurysms, depending on their configurations. To describe a variant of the Y-configuration stent-assisted coiling technique for the treatment of basilar tip aneurysms with wide necks. This technique, called the nonoverlapping Y stenting technique, consists of the deployment of a closed-cell self-expandable stent from the basilar trunk to a posterior cerebral artery and then placement of a second stent from the basilar bifurcation to the other posterior cerebral artery without overlapping the first stent. The proximal flared portion of the second stent was located at the neck of the aneurysm. Coil embolization was performed under dual-stent protection. We successfully filled wide-neck aneurysms with coils under stent protection by forming a bridge across the aneurysmal neck without overlapping 2 closed-cell stents. Six basilar tip aneurysms were successfully treated with this technique. The nonoverlapping Y stenting technique is a good alternative to traditional stent-assisted coiling. This technique is particularly suitable for the treatment of broad-neck bifurcation aneurysms.

Endovascular Treatment of Basilar Tip Aneurysms with Guglielmi Detachable Coils: Predictors of Immediate and Long-term Results with Multivariate Analysis—6-year Experience

To analyze anatomic and clinical results and factors predictive of outcome in treatment of basilar tip aneurysms with Guglielmi detachable coils (GDCs). During 6 years, 55 unselected consecutive saccular aneurysms in 53 patients (mean age, 47 years) were treated with GDC occlusion. Forty-one (75%) aneurysms were ruptured (Hunt-Hess and Fisher grades were assigned in patients); 14 (25%), unruptured. Clinical and angiographic evaluations were performed 6 months after treatment and during follow-up (mean follow-up, 2 years). Multivariate analysis was used to determine factors predictive of outcome. GDC occlusion was a success in 52 (95%) aneurysms, a failure in two (4%), and not attempted in one (2%). Occlusion at final follow-up, evaluated in 44 aneurysms, was complete in 34 (77%), near complete in four (9%), and incomplete in six (14%). At 6-12 months, mean aneurysmal occlusion rate significantly worsened because of revascularization (P <.001) but improved at final follow-up because of reembolization in 10 aneurysms (P =.009); it remained stable (P =.351) between initial and final follow-up. Multivariate binary logistic regression indicated that before treatment started, aneurysmal neck size was the only independent predictor of initial occlusion rate (P =.002) and revascularization (P =.004). After the initial procedure, sac size and initial occlusion rate were independent predictors of revascularization (P =.004 and.008, respectively), irrespective of neck size. Occlusion rate at 6-12-month follow-up was the only independent predictor of that at final follow-up (P =.021), regardless of shape of aneurysm. Overall morbidity was 2% (one of 51); mortality, 6% (three of 51). Mortality correlated significantly with Hunt-Hess grade 4 at admission (P =.003) and incidence of vasospasm (P =.058). GDC occlusion proved to be a safe effective therapeutic alternative to surgery in patients with ruptured or unruptured basilar tip aneurysms. Morphologic and clinical factors were respectively identified as predictors of the optimal anatomic and clinical outcomes.

Endovascular Treatment of Basilar Tip Aneurysms Using Guglielmi Detachable Coils: Anatomic and Clinical Outcomes in 73 Patients from a Single Institution

Endovascular Treatment of Basilar Tip Aneurysms Using Guglielmi Detachable Coils: Anatomic and Clinical Outcomes in 73 Patients from a Single Institution

Endovascular Treatment of Basilar Tip Aneurysms Using Guglielmi Detachable Coils: Anatomic and Clinical Outcomes in 73 Patients from a Single Institution

Seventy-three consecutive patients with 75 basilar tip aneurysms were treated with Guglielmi detachable coil (GDC) technology. Their anatomic and clinical outcomes are discussed. Seventy-five basilar tip aneurysms were treated with the GDC system at the University of California, Los Angeles Medical Center from 1990 to 1999. The average age of the population was 48.3 years (range, 28-82 yr). Forty-two patients (57.5%) presented with acute subarachnoid hemorrhage, 8 patients (10.9%) had unruptured aneurysms with mass effect, and 23 patients (31.5%) had incidental aneurysms. Thirty-one aneurysms (41.3%) were small with a small neck, 18 (24%) were small with a wide neck, 16 (21.3%) were large, and 10 (13.3%) were giant aneurysms. Immediate anatomic outcomes demonstrated complete or near-complete occlusion in 64 aneurysms (85.3%) and incomplete occlusion in 7 aneurysms (9.3%). Four aneurysms (5.3%) could not be embolized because of anatomic difficulties. Of the 69 patients treated with GDCs, 63 patients (91.3%) remained neurologically intact or unchanged from their initial clinical status. Procedure-related morbidity and mortality were 4.1% and 1.4%, respectively. Long-term follow-up angiograms were obtained in 41 patients with 42 aneurysms. Thirty aneurysms (71.4%) demonstrated complete or near-complete occlusion. One incompletely embolized giant aneurysm ruptured during the follow-up period. In contrast to surgical clipping of basilar tip aneurysms, the main technical challenge of the Guglielmi detachable coiling procedure depends on the shape of the aneurysm, not its location. The results of this study indicate that endovascular GDC technology is an appropriate therapeutic alternative in ruptured or unruptured basilar tip aneurysms regardless of patient age, clinical presentation, clinical status, or timing of treatment.

Posterior communicating artery section during surgery for basilar tip aneurysm.

Although dividing the posterior communicating artery (PComA) during surgery has been criticized for increasing the risk of ischaemia, this procedure increase working space improving visibility and the ability to manipulate during treatment of basilar tip aneurysms via the pterional approach. We divided a hypoplastic PComA in 4 of our cases of basilar tip aneurysm. This was necessary because either (1) the length of the PComA and intracranial internal carotid artery (ICA) limited medial retraction of the ICA and access to the basilar bifurcation region, or (2) the PComA and its perforators ran just in front of the aneurysm, interfering with its exposure. We were able to clip the aneurysm neck in all four patients, three of whom had complications including temporary impairment of consciousness, ocular movement disorders and altered sensation in the extremities. Patients with complications showed transient hypersomnolence immediately after surgery; computed tomography showed small thalamic infarctions. However, in two of three patients the ischaemic events occurred contralateral to the side of PComA section. All patients regained consciousness within a week and were discharged with mild ocular movement palsies. In our cases except one with ischaemic complications, thalamic infarction probably resulted from thalamo-perforating artery injury when the aneurysm neck was clipped, rather than tuberothalamic artery injury due to section of the PComA. Taking previous reports and our results into consideration, we believe that division of a hypoplastic PComA is a safe procedure in particular cases when the grade of subarachnoid haemorrhage is not poor and there are no cerebrovascular risk factors, although we realize it is desirable to preserve normal blood flow.