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Original research
Endovascular treatment of fusiform intracranial aneurysms
  1. Kavi K Devulapalli1,
  2. Shakeel A Chowdhry2,
  3. Nicholas C Bambakidis2,
  4. Warren Selman2,
  5. Daniel Pierce Hsu3
  1. 1Case Western Reserve University, Cleveland, Ohio, USA
  2. 2Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
  3. 3Department of Interventional Neuroradiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
  1. Correspondence to Dr Daniel Pierce Hsu, Department of Interventional Neuroradiology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA; daniel.hsu{at}uhhospitals.org

Abstract

Background and purpose Endovascular treatment (EVT) has emerged as an alternative therapeutic strategy for the treatment of intracranial fusiform aneurysms (IFAs), but little is known about the safety and efficacy of deconstructive and reconstructive methods, especially in patients presenting with subarachnoid hemorrhage (SAH). The purpose of this study is to describe the radiological and clinical outcomes in patients with IFAs undergoing EVT.

Methods A retrospective analysis was conducted of 18 patients undergoing EVT of IFAs, 13 of whom (72.2%) presented with SAH. Radiological outcomes were characterized by the presence of parent vessel opacification and aneurysmal remnants for patients undergoing deconstructive and reconstructive EVT, respectively. Clinical outcomes were characterized by the Glasgow Outcome Scale. Contingency analysis of factors associated with clinical outcomes in patients with ruptured aneurysms was conducted.

Results Technical success was achieved in 17 of the 18 patients (94.4%), with 10 (55.6%) undergoing reconstructive EVT and eight (44.4%) undergoing deconstructive EVT. For patients with SAH, favorable clinical outcomes were achieved in 9/13 (69.2%), with 3/6 (50.0%) undergoing reconstructive EVT and 6/7 (85.7%) undergoing deconstructive EVT. Among patients with ruptured aneurysms, only Hunt–Hess grade ≥3 was associated with an unfavorable clinical outcome (p=0.007). Favorable clinical outcomes were seen in all five patients with unruptured aneurysms.

Conclusion Both deconstructive and reconstructive EVT were found to be safe and effective in patients with unruptured aneurysms. Reconstructive EVT may be associated with a higher incidence of poor clinical outcomes in patients presenting with high-grade SAH.

  • Endovascular
  • subarachnoid hemorrhage
  • intracranial fusiform aneurysm
  • outcomes
  • aneurysm
  • intervention
  • artery
  • temporal bone
  • MRI
  • CT
  • subarachnoid

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Footnotes

  • Competing interests None.

  • Ethics approval Institutional Review Board approval was obtained for this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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