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Case series
Basilar artery trunk aneurysm: clinical and angiographic outcomes of endovascular treatment
  1. Sook Young Sim1,
  2. Joonho Chung2,
  3. Jai Ho Choi3,
  4. Myeong Jin Kim4,
  5. Yong Sam Shin3,
  6. Yong Cheol Lim5
  1. 1Department of Neurosurgery, Inje University Ilsan Paik Hospital, Goyang, Korea (the Republic of)
  2. 2Department of Neurosurgery, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
  3. 3Department of Neurosurgery, Catholic University of Korea School of Medicine, Seoul, Seoul, Korea (the Republic of)
  4. 4Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Incheon, Korea (the Republic of)
  5. 5Department of Neurosurgery, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Gyeonggi-do, Korea (the Republic of)
  1. Correspondence to Dr Yong Cheol Lim, Department of Neurosurgery, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Gyeonggi-do 443-721, Korea (the Republic of); nsyclim{at}gmail.com; Dr Joonho Chung, Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; ns.joonho.chung{at}gmail.com

Abstract

Background Basilar artery (BA) trunk aneurysms are rare, and the clinical characteristics and outcomes of endovascular treatment (EVT) remain unclear. The purpose of this study was to report clinical and angiographic outcomes of BA trunk aneurysm treated with EVT and to analyze risk factors for unfavorable outcomes.

Methods From October 2004 to December 2020, a total of 40 patients with BA trunk aneurysms underwent EVT. Clinical characteristics and outcomes were evaluated retrospectively from a prospectively collected database. Of the 40 enrolled patients, nine were treated by coiling without stents, 17 were treated by stent-assisted coiling, six by stent only, five by flow diverters, and three by vertebral artery occlusion.

Results In total, 27 (67.5%) patients had subarachnoid hemorrhage as an initial presentation, and 20 (50.0%) had large/giant aneurysms. Procedure-related complications occurred in five patients (12.5%); favorable clinical outcome was achieved in 27 patients (67.5%); and six patients (15.0%) died. Favorable angiographic outcome was achieved in 26 (83.9%) of 31 patients who underwent follow-up angiography. Poor initial Hunt-and-Hess grade (OR 7.67, 95% CI 1.55 to 37.80; p=0.018) was the only independent risk factor for unfavorable clinical outcome. Large/giant aneurysm (OR 8.14, 95% CI 1.88 to 27.46; p=0.047) and long lesion (OR 14.25, 95% CI 1.48 to 69.80; p=0.013) were independent risk factors for unfavorable angiographic outcomes during follow-up.

Conclusions EVT might be a feasible option for this rare disease entity. Unfavorable angiographic outcome might be expected in a large/giant aneurysm or a long lesion. It can be difficult to treat BA trunk aneurysms by EVT, needing multiple procedures or various techniques due to diverse clinical and angiographic features.

  • aneurysm
  • artery
  • intervention
  • stent

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Footnotes

  • JC and YCL contributed equally.

  • Contributors Substantial contribution to the conception or design of the work: JC and YCL. Acquisition, analysis, or interpretation of the data for the work: SYS, JC, JHC, MJK, YSS, and YCL. Drafting the work or revising it critically for important intellectual content: SYS, JC, JHC, MJK, YSS, and YCL. Final approval of the version to be published: SYS, JC, JHC, MJK, YSS, and YCL. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: SYS, JC, JHC, MJK, YSS, and YCL.

  • Funding This work was supported by (a Grant from Research Year of Inje University) grant number [20 170 109].

  • Competing interests None declared.

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

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