Unfavorable Outcomes Related to Endovascular Treatment of Giant Vertebrobasilar Aneurysms

Abstract

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Background: Giant vertebrobasilar aneurysms (GVBAs) have an unfavorable natural history if left untreated and often pose a sizeable challenge to endovascular treatment. The aim of this study was to analyze the angiographic and clinical outcomes of GVBAs treated by various endovascular procedures.Methods: Between January 2010 and September 2018, 27 patients with 27 GVBAs treated endovascularly were enrolled in this consecutive study. The clinical and angiographic features, treatment modalities, and outcomes were analyzed.Results: The patient cohort comprised 21 men (77.8%) and 6 women (22.2%) of mean age 42.7 ± 18.9 years (range, 6–65 years). The most common presenting symptom was compressive symptoms, present in 15 patients (55.6%). None of the GVBAs was ruptured. Of the 27 GVBAs, 23 aneurysms were dissecting aneurysm with intramural hematoma and 4 aneurysms were saccular. Regarding treatment approach, internal trapping was used in 5 aneurysms, stent-assisted coil embolization in 10, sole stenting in 4, and flow diverters in 8. Overall, 12 patients (44.4%) had an unfavorable angiographic or clinical outcome: 3 patients presented with post-operative complications and subsequent death, and 9 with poor prognosis during follow-up.Conclusions: Patients with GVBAs may not benefit from endovascular treatment. Newer-generation devices are necessary to provide more optimal therapy for the management of these complex lesions.

Keywords

• giant vertebrobasilar aneurysms
• endovascular treatment
• outcome
• complications
• poor prognosis