Seung Pil Ban1, Gyojun Hwang2, Chang Hyeun Kim3, Hyoung Soo Byoun1, Si Un Lee1, Tackeun Kim1, Jae Seung Bang1, Chang Wan Oh1, O-Ki Kwon4. 1. Department of Neurosurgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea. 2. Department of Neurosurgery, Hallym University Hangang Sacred Heart Hospital, Seoul, South Korea. 3. Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, South Korea. 4. Department of Neurosurgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea. meurokwonoki@gmail.com.
Abstract
PURPOSE: Only a few reports of internal carotid artery (ICA) bifurcation aneurysms using the endovascular technique have been published in the current literature. The purpose of this study was to assess how multiple risk factors including angioarchitectural features of ICA bifurcation characteristics may have influenced aneurysmal rupture, recanalization, and retreatment. METHODS: Fifty-one patients with 52 ICA bifurcation aneurysms treated with endovascular coiling between July 2003 and July 2015 were retrospectively analyzed. The patients' clinical records, endovascular reports, and clinical and angiographic outcomes were reviewed. We also evaluated risk factors for recanalization and retreatment, including the angioarchitectural anatomy. RESULTS: The clinical outcomes were observed to be satisfactory in 49 patients (96.0%) and unfavorable in 2 patients (4.0%). The risk factor for aneurysmal rupture was young age (P = 0.024). Symptomatic complications due to thromboembolism occurred in 1.9% of cases; no patients suffered a fatal complication. Eleven of 52 ICA bifurcation aneurysms (21.2%) were recanalized within an average of 54.3 ± 33.5 months of follow-up. Among the aneurysms, 4 (7.7%) underwent recoiling. Multivariate analysis showed that ruptured aneurysms (P = 0.006) and a lower packing density (P = 0.048) were risk factors for recanalization. A lower packing density was the only risk factor for retreatment (P = 0.019). CONCLUSION: Endovascular treatment of ICA bifurcation aneurysms is considered safe and acceptable. This study showed that the ICA bifurcation aneurysms ruptured more frequently at a younger age. A higher packing density has been shown to reduce major recanalization and retreatment.
PURPOSE: Only a few reports of internal carotid artery (ICA) bifurcation aneurysms using the endovascular technique have been published in the current literature. The purpose of this study was to assess how multiple risk factors including angioarchitectural features of ICA bifurcation characteristics may have influenced aneurysmal rupture, recanalization, and retreatment. METHODS: Fifty-one patients with 52 ICA bifurcation aneurysms treated with endovascular coiling between July 2003 and July 2015 were retrospectively analyzed. The patients' clinical records, endovascular reports, and clinical and angiographic outcomes were reviewed. We also evaluated risk factors for recanalization and retreatment, including the angioarchitectural anatomy. RESULTS: The clinical outcomes were observed to be satisfactory in 49 patients (96.0%) and unfavorable in 2 patients (4.0%). The risk factor for aneurysmal rupture was young age (P = 0.024). Symptomatic complications due to thromboembolism occurred in 1.9% of cases; no patients suffered a fatal complication. Eleven of 52 ICA bifurcation aneurysms (21.2%) were recanalized within an average of 54.3 ± 33.5 months of follow-up. Among the aneurysms, 4 (7.7%) underwent recoiling. Multivariate analysis showed that ruptured aneurysms (P = 0.006) and a lower packing density (P = 0.048) were risk factors for recanalization. A lower packing density was the only risk factor for retreatment (P = 0.019). CONCLUSION: Endovascular treatment of ICA bifurcation aneurysms is considered safe and acceptable. This study showed that the ICA bifurcation aneurysms ruptured more frequently at a younger age. A higher packing density has been shown to reduce major recanalization and retreatment.
Authors: Maarten Uyttenboogaart; Roy E Stewart; Patrick C A J Vroomen; Jacques De Keyser; Gert-Jan Luijckx Journal: Stroke Date: 2005-08-04 Impact factor: 7.914
Authors: Dittapong Songsaeng; Sasikhan Geibprasert; Karel G ter Brugge; Robert Willinsky; Michael Tymianski; Timo Krings Journal: J Neurosurg Date: 2010-10-08 Impact factor: 5.115