TITLE:
Outcomes of Endovascular Treatment of Intracranial Aneurysms at Bifurcation Sites
AUTHORS:
Ahmed Saied, Mohamed Gomaa, Talal Amer, Mohamed Saad, Demetrius Lopes
KEYWORDS:
Bifurcation Aneurysm, Stent Assisted Coiling, Recanalization, Simple Coiling
JOURNAL NAME:
World Journal of Neuroscience,
Vol.8 No.4,
November
1,
2018
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.