Early and long-term outcomes of endovascular treatment in patients with symptomatic and asymptomatic cerebral arteries microaneurysms

Abstract

Objective ‒ to evaluate the effectiveness of endovascular treatment methods in patients with cerebral artery microaneurysms at different stages of the disease, based on the analysis of procedural complications and the radicality of aneurysm occlusion, as well as to analyze the clinical manifestations of the disease depending on age. Materials and methods. Archival data of 2,665 patients with saccular aneurysms of cerebral arteries treated endovascularly at the SO «Scientific Practical Center of Endovascular Neuroradiology NAMS of Ukraine» from 2003 to 2023 were analyzed, including 281 (10.5%) patients with microaneurysms. For the study, 162 (6.0%) cases were selected based on inclusion and exclusion criteria. Patients were divided into two groups: 59 (36.4%) had asymptomatic aneurysms (Group I), and 103 (63.6%) had symptomatic aneurysms (Group II). The effectiveness and safety of various endovascular treatment techniques for microaneurysms were evaluated, including intraoperative and long-term complications. The modified Rankin scale was used to assess quality of life and social adaptation of patients before discharge. The mean age of patients with symptomatic aneurysms was (47.94 ± 11.48) years, which was statistically significantly higher compared to asymptomatic patients (42.66 ± 7.47) years. A statistically significant association between age group and symptom presence was identified (χ² = 97.775, p 0.05). Effective primary occlusion was achieved in 97% of cases in Group I and 98% in Group II. In Group I, the frequency of hemorrhagic complications was 3.7% with the mono-spiral technique, whereas no hemorrhagic intraoperative complications were recorded with assisted techniques. Ischemic intraoperative complications occurred in 11% of cases using the mono-spiral technique and in the one case with the stent-assisted technique. In Group II, no intraoperative hemorrhagic complications were observed; the frequency of ischemic complications was 3.3% with the balloon-remodeling technique. Long-term occlusion outcomes were assessed in 62 (60.2%) patients in Group I and in 32 (54.2%) patients in Group II. Conclusions. Microaneurysms are more common in middle-aged individuals. Ruptured microaneurysms with intracranial hemorrhage are characteristic of middle-aged patients. A statistically significant association between age group and symptom presence was identified (χ² = 97.775, p < 0.001). The radicality of endovascular occlusion of microaneurysms does not depend on clinical manifestations or the stage of the disease when different endovascular techniques are applied. High levels of primary occlusion and its stability in the long term were achieved in patients with both symptomatic and asymptomatic disease courses. The frequency of intraoperative complications in patients with symptomatic and asymptomatic microaneurysms does not differ statistically significantly and is independent of the occlusion technique used.

Keywords

• microaneurysm; endovascular occlusion; intracranial hemorrhage; mono-spiral technique; balloon-remodeling technique; stent-assisted technique.