Introduction The treatment of intracranial aneurysms has always garnered great attention and controversy. Since the mid-1990s Endovascular therapy has become an important tool in the surgeon’s armamentarium. Recent studies have demonstrated the utility of endovascular therapy in the treatment of both ruptured and unruptured aneurysms. Newer devices have allowed safe therapy on complex and previously untreatable lesions. We present a large cohort of patients who presented with complex aneurysms and were treated at a single institution.
Methods Patients who presented with complex, unruptured aneurysms to a single institution in Bogotá, Colombia between June 2007 and June 2016 were enrolled. Complex aneurysms were defined as a neck-to-dome ratio over 1.0, multilobulated or distal (P2/P3 junction, A3, M3 segments or beyond) location. Complete patient demographical data, aneurysm location, size and morphology and treatment modality were recorded. Clinical and angiographic follow-up was obtained no less than 18 months after treatment. Intraoperative and 30 day postoperative morbidity and mortality as well as lesion recurrence or recanalization were obtained. Multi-variate analyses were performed to determine which variables had impact on patient outcome and lesion recurrence.
Results One-hundred and sixty-two (162) patients with two-hundred and thirty-two (232) aneurysms were enrolled and followed for an average of 32 months (Range 18.5–62). Seventy-two patients (44%) were male. Average age was 55.5 years of age (Range 28–79). Average BMI was 24.2 (Range 19.8–32.4). Ninety-five patients (58.6%) had a history of smoking at least ten pack-years. All aneurysms were treated with either stand-alone coiling (22%), balloon-assisted coiling (15%), stent-assisted coiling (51%) or flow-diversion devices (12%). Intraoperative morbidity (coil migration, device occlusion, distal embolization) was 3.5%. 30 day morbidity (procedure-related complications) was 2.9%. One patient died on POD 18 of a Pulmonary Embolism. There were no other procedure-related deaths at 30 days. Modified Raymond-Roy occlusion class I was obtained on 182 aneurysms (78.4%) on immediate post-operative angiogram, 12% had RROC Class II and 10% had residual aneurysm (RROC Class III). On 18 month follow-up, 82% of RROC Class I aneurysms were angiographically excluded. Ten lesions (4.3%) required additional treatment. No cases of subarachnoid haemorrhage were recorded in our cohort. Pre-procedural smoking, BMI ≥30 and RROC had statistically significant impact on lesion recurrence.
Conclusions A large cohort of complex aneurysms is presented. Although immediate, complete lesion occlusion is relatively low (78%) the complexity of the lesions and the learning curve of the endovascular neurosurgeons might explain this finding. However, long-term results are similar to those previously reported in the literature. The fact that high BMI and previous history of Smoking had a statistically significant impact on outcome warrants the question of whether preoperative weight control and smoking cessation should be indicated in elective, unruptured aneurysm treatment.
Disclosures P. Harker: 4; C; Biotronitech Colombia S.A. P. Baldrich: None. A. Pulido-Saavedra: None. J. Puentes: None.
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