Endovascular treatment of aneurysms of the upper third of the basilar artery

This work is devoted to the study of the immediate and long-term results of treatment of patients with aneurysms of the upper third of the basilar artery with the use of endovascular treatment methods.

PURPOSE OF THE STUDY: To evaluate the immediate and long-term results of endovascular treatment of patients with aneurysms of the upper third of the basilar artery.

MATERIAL AND METHODS. The results of endovascular treatment of 91 patients with 95 aneurysms of the upper third of the basilar artery operated in the neurosurgical department #3 of the Prof. A.L. Polenov Russian Research Neurosurgical Institute from January 1, 2017 to March 31, 2023 were analyzed.

RESULTS. The following endovascular methods were used: 1) selective aneurysm coiling (n=39); 2) stent-assisted coiling (n=35); 3) implantation of flow-diverting stent (n=21). Grade of occlusion for aneurysms treated with selective aneurysm coiling and stent-assisted coiling was classified according to the Raymond-Roy classification, as well as according to the Cekirge-Saatci classification for aneurysms treated with flow-diverting stents.

In the group after spiral occlusion, 23 (60.5 %) aneurysms were totally (Class A), 8 (21.1 %) were subtotally (Class b), and 7 (18.4 %) were partially (Class C) occluded.

In the group after stent-assisted coiling totally occluded (Class A) were 22 (61.1 %), subtotally (Class b) — 8 (22.2 %) and partially (Class C) — 6 (16.6 %), with no statistically significant differences in the group of braided and laser-cut stents (p = 0.571).

In the group after implantation of the flow-diverting stent, primary reconstruction (grade 4A) was achieved in 15 (71.4 %) cases.

Control cerebral angiography at a period not earlier than 6 months was performed in 72.5 % (n=69) of patients.

In the long-term follow-up after aneurysm occlusion with detachable coils, control angiography was performed in 73.7 % (28/38) of observations, totally occluded (Class A) were 16 (57.1 %) and partially (Class C) — 12 (42.9 %). In this group the recurrence rate was 21.4 % (n=6), in 10.7 % (n=3) requiring repeated surgical intervention. In the remote period after aneurysm occlusion with stent-assisted coiling, control angiography was performed in 66.7 % (24/36). After occlusion of aneurysms with usage of stents made by laser cutting technology in the remote period there was a decrease in radicality of aneurysms occlusion — (Class A) — 5 (38,4 %) and partially (Class C) — 8 (61,5 %). There were 7 recurrences in this group of cases, 4 of which required repeated surgical treatment. In the remote period after occlusion of aneurysms with stent-assisted coiling, with usage of braided stents there was an increase in radicality of aneurysms occlusion from blood flow. Totally were occluded (Class A) 10 (90.9 %) and partially (Class C) — 1 (9.1 %). In this group, 1 (9.1 %) recurrence was identified. In the remote period after implantation of the flow-diverting stent, total/subtotal aneurysm occlusion was observed in 47 % (n=8) of cases.

Clinically, the postoperative outcome was excellent in 83 (87.9 %) patients (mRS score 0–1); 7(7.7 %) patients had mild impairment (score 2–3), 3 (3.3 %) patients had severe impairment (score 4–5), and 1 (1.1 %) patient died (score 6).

Complications related to surgery were observed in 4.2 % (n=4) of observations, of which 3.2 % (n=3) affected the final patient outcome.

In the remote period after implantation of the flow-diverting stent, total/subtotal aneurysm occlusion was observed in 47 % (n=8) of cases.

Clinically, the postoperative outcome was excellent in 83 (87.9 %) patients (mRS score 0–1); 7(7.7 %) patients had mild impairment (score 2–3), 3 (3.3 %) patients had severe impairment (score 4–5), and 1 (1.1 %) patient died (score 6).

Complications related to surgery were observed in 4.2 % (n=4) of observations, of which 3.2 % (n=3) affected the final patient outcome.

CONCLUSION. Endovascular treatment of aneurysms of the upper third of the basilar artery with microspirals and / or with the use of other modern endovascular techniques is effective and safe enough. The use of modern braided assisting stents allows to achieve higher radicality of aneurysm occlusion in the long term period. Safety and efficacy of flow-directing stents in the treatment of aneurysms of the upper third of the basilar artery require further study; however, our results indicate the possibility of their effective usage of this treatment modality for complex aneurysms of this localization.

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