Background Due to the presence of a high morbidity and mortality associated with surgical clipping, most of patients with basilar artery bifurcation (BA) aneurysm are offered endovascular therapy. Objective of our study is to report our technical and clinical outcomes of BA ruptured patients who underwent endovascular therapy.
Methods Consecutive patients with the diagnosis of ruptured BA aneurysms who underwent endovascular repair of aneurysm from 2007 to 2011 were enrolled. Patient's demographics including presenting Hunt & Hess (H&H) grade, Fisher scale, and aneurysm's morphology, use of stent, intra-operative complications and radiographic outcome were measured. Additionally, a 90 days clinical outcome was measured using Glasgow Outcome Scale (GOS).
Results 20 patients with a mean age of 51±13 year underwent successful repair of the ruptured BA bifurcation aneurysms. Most of the patient were women (80%) and 75% of patients were active smoker. H&H I was present in 6 (30%), H&H II in 4 (20%), H&H III in 3 (15%), H&H IV in 6 (30%) and H&H V in 1 (5%) of patients. 10 patients with wide-necked aneurysms required stent-assisted coiling in the acute phase and were given oral loading doses of clopidogrel (300 mg) and aspirin (325 mg) at least 2 h prior to the stent deployment. There was no incidence of intra-operative or postoperative intracranial or systemic hemorrhages or thromboembolic event. Immediate complete (7) and near complete (9) obliteration was observed in 80% and subtotal in 4 (20%) of patients. 30 days good outcome (GOS 5 in 12, GOS 4 in four) was observed in 80% of patients including four of seven patients presented with poor grades (H&H IV & H&H V). Poor outcome (GOS 3) was observed in 4 (20%) of patients. When these patient were examined in 90 days; good outcome (GOS 5 in 14, GOS 4 in four) was observed in 90% including six of the seven patients who had presenting poor grades.
Conclusions Endovascular techniques offer successful repair of ruptured BA aneurysms including those with wide neck and required stent-assisted coiling. Good outcome was observed in most of our patients including those with poor clinical grade. Poor H&H grade was not associated with poor long-time outcome in our series. Further study is required to evaluate the role of Hunt & Hess grade in BA aneurysm in a broader scale.
Competing interests None.
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