Hanna Styczen1, Sebastian Fischer2, Matthias Gawlitza3, Lukas Meyer4, Lukas Goertz5, Christoph Maurer6, Maria Alexandrou7, Ali Khanafer8, Donald Lobsien9, Cornelius Deuschl1, Joachim Klisch9, Christoph Kabbasch5, Jens Fiehler4, Ansgar Berlis6, Panagiotis Papanagiotou7,10, Hans Henkes8, Volker Maus2. 1. Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany. 2. Department of Radiology, Neuroradiology and Nuclear Medicine, Ruhr-University Bochum, Germany. 3. Institute of Neuroradiology, University Hospital Carl Gustav Carus, Germany. 4. Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Germany. 5. Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Germany. 6. Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Germany. 7. Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte, Germany. 8. Neuroradiological Clinic, Klinikum Stuttgart, Germany. 9. Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Germany. 10. Department of Radiology, Aretaieion University Hospital, Greece.
Abstract
BACKGROUND: Data on outcome after endovascular treatment of basilar artery fenestration aneurysms (BAFAs) is limited. This study presents our multi-centre experience of BAFAs treated by different reconstructive techniques including coils, stent-assisted coiling (SAC), flow diversion and intra-saccular flow disruption with the Woven Endobridge (WEB). METHODS: Retrospective analysis of 38 BAFAs treated endovascularly between 2003 and 2020. The primary endpoint was complete aneurysm obliteration defined as Raymond-Roy occlusion classification (RROC) I on immediate and follow-up (FU) angiography. The secondary endpoints were procedure-related complications, rate of re-treatment, and clinical outcome. RESULTS: Endovascular treatment was feasible in 36/38 aneurysms (95%). The most frequent strategy was coiling (21/36, 58%), followed by SAC (7/36, 19%), WEB embolization (6/36, 17%) and flow diversion (2/36, 6%). A successful aneurysm occlusion (defined as RROC 1 and 2) on the final angiogram was achieved in 30/36 (83%) aneurysms including all patients presenting with baseline subarachnoid haemorrhage and 25/36 (69%) were occluded completely. Complete occlusion (RROC 1) was more frequently achieved in ruptured BAFAs (15/25, 60% v. 2/11, 18%; p = 0.031). Procedure-related complications occurred in 3/36 (8%) aneurysms. Re-treatment was executed in 12/36 (33%) aneurysms. After a median angiography FU of 38 months, 30/31 (97%) BAFAs were occluded successfully and 25/31 (81%) showed complete occlusion. CONCLUSION: Reconstructive endovascular treatment of BAFAs is technically feasible with a good safety profile. Although in some cases re-treatment was necessary, a high rate of final aneurysm occlusion was achieved.
BACKGROUND: Data on outcome after endovascular treatment of basilar artery fenestration aneurysms (BAFAs) is limited. This study presents our multi-centre experience of BAFAs treated by different reconstructive techniques including coils, stent-assisted coiling (SAC), flow diversion and intra-saccular flow disruption with the Woven Endobridge (WEB). METHODS: Retrospective analysis of 38 BAFAs treated endovascularly between 2003 and 2020. The primary endpoint was complete aneurysm obliteration defined as Raymond-Roy occlusion classification (RROC) I on immediate and follow-up (FU) angiography. The secondary endpoints were procedure-related complications, rate of re-treatment, and clinical outcome. RESULTS: Endovascular treatment was feasible in 36/38 aneurysms (95%). The most frequent strategy was coiling (21/36, 58%), followed by SAC (7/36, 19%), WEB embolization (6/36, 17%) and flow diversion (2/36, 6%). A successful aneurysm occlusion (defined as RROC 1 and 2) on the final angiogram was achieved in 30/36 (83%) aneurysms including all patients presenting with baseline subarachnoid haemorrhage and 25/36 (69%) were occluded completely. Complete occlusion (RROC 1) was more frequently achieved in ruptured BAFAs (15/25, 60% v. 2/11, 18%; p = 0.031). Procedure-related complications occurred in 3/36 (8%) aneurysms. Re-treatment was executed in 12/36 (33%) aneurysms. After a median angiography FU of 38 months, 30/31 (97%) BAFAs were occluded successfully and 25/31 (81%) showed complete occlusion. CONCLUSION: Reconstructive endovascular treatment of BAFAs is technically feasible with a good safety profile. Although in some cases re-treatment was necessary, a high rate of final aneurysm occlusion was achieved.
Authors: Jean Raymond; François Guilbert; Alain Weill; Stavros A Georganos; Louis Juravsky; Anick Lambert; Julie Lamoureux; Miguel Chagnon; Daniel Roy Journal: Stroke Date: 2003-05-29 Impact factor: 7.914
Authors: Daniel L Cooke; Charles E Stout; Warren T Kim; Akash P Kansagra; John Paul Yu; Amy Gu; Nicholas P Jewell; Steven W Hetts; Randall T Higashida; Christopher F Dowd; Van V Halbach Journal: Interv Neuroradiol Date: 2014-06-17 Impact factor: 1.610