Highlights
- •Proximal parent artery stenosis ≥ 50% independently predicted the incomplete occlusion of small ruptured aneurysms.
- •Higher rates of intraprocedural rupture, thromboembolic complications, intraprocedural vasospasm, and mortality tended to occur in patients with complete occlusion.
- •Complete occlusion of small ruptured aneurysms can be achieved without additional mortality and perioperative complications.
Abstract
Background and objective: There are technical challenges to complete occlusion of small (<5 mm) ruptured intracranial
aneurysms (SRAs) using endovascular treatment (EVT). This study analyzed factors influencing
immediate angiographic results in SRAs after EVT. Material and Methods: Intraoperative angiograms and medical records of 290 patients, who underwent EVT
for SRAs at 2 stroke centers in China between January 2009 and October 2016, were
retrospectively reviewed and evaluated. Results: Immediate complete occlusion was achieved in 213 (73.4%) aneurysms. Aneurysms with
a smaller aspect ratio, those less than 3 mm in size, irregular shape, small basal
outpouching, multiple aneurysms, poorer Hunt and Hess grade, and location of communication
arteries demonstrated higher rates of incomplete occlusion, although the differences
were not statistically significant. Multivariate logistic regression analysis revealed
that SRAs with parent artery stenosis greater than or equal to 50% and lobulation
demonstrated a higher incidence of incomplete occlusion. Intra-procedural rupture
occurred in 13 (6.1%) patients in the complete occlusion group, and 3 (3.9%) in the
incomplete occlusion group (P = .467). Thromboembolic complications occurred in 3 (1.0%) patients, and 4 (1.9%)
underwent decompressive craniotomy after EVT, all of whom were in the complete occlusion
group. Nine (4.2%) patients in the complete occlusion group and 2 (2.6%) in the incomplete
occlusion group (P = .733) experienced intraprocedural vasospasm, with corresponding morbidity and mortality
rates of 15.0% and 2.1%, respectively. Conclusions: Proximal parent artery stenosis greater than or equal to 50% and lobulation were
independent predictors of incomplete occlusion in patients with SRAs. Higher rates
of intraprocedural rupture, thromboembolic complications, intraprocedural vasospasm,
and mortality were found in the complete occlusion group; however, these differences
were not statistically significant. Complete occlusion of SRAs may be achieved without
additional mortality and perioperative complications.
Key Words
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Article info
Publication history
Published online: March 26, 2020
Accepted:
December 22,
2019
Received in revised form:
November 20,
2019
Received:
September 17,
2019
Footnotes
Funding: This research was supported by the China National Key R&D Program during the 13th Five-year Plan Period (grant no. 2015BAI12B04), Beijing Hospital Clinical Research 121 Program (grant no. 121-2016006), the National Natural Science Foundation of China (no. 81771233), and Specific Research Projects for Capital Health Development (2018-2-2041).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104624
Copyright
© 2020 Elsevier Inc. All rights reserved.
