Endovascular treatment of ruptured basilar artery trunk aneurysm in the acute period: risk factors for periprocedural complications

ABSTRACT

Objectives

Endovascular treatment (EVT) has become a popular option for the treatment of basilar artery (BA) trunk aneurysms because microsurgery of these lesions is difficult due to narrow surgical fields and perforating arteries or cranial nerves in the brainstem. The purpose of this study is to report our experiences using EVT for ruptured BA trunk aneurysms in the acute period and to evaluate the risk factors for periprocedural complications.

Methods

From October 2004 to December 2020, a total of 27 consecutive patients with ruptured BA trunk aneurysms were treated with EVT. All patients met the following criteria: presence of ruptured BA trunk aneurysms and treatment with EVT for those aneurysms within 72 hours of rupture. The incidence of and risk factors for periprocedural complications were evaluated retrospectively.

Results

Among the 27 patients, periprocedural complications occurred in 4 patients (14.8%); mass effect inducing cranial neuropathy due to brainstem compression in 1 (3.7%) and brainstem infarction in 3 (11.1%). Hemorrhagic complications did not occur within 30 days. Subacute or delayed thromboembolic complications were not observed during the follow-up period. Large/giant aneurysm (odds ratio [OR], 6.417; 95% confidence interval [CI], 1.732–18.031; P = 0.045) and stent-assisted coiling (OR, 4.145; 95% CI, 1.018–14.212; P = 0.031) remained independent risk factors for periprocedural complications based on multiple logistic regression analysis.

Conclusions

When performing stent-assisted coiling for ruptured large/giant BA trunk aneurysms, awareness of and caution regarding periprocedural complications, such as brainstem infarction caused by thromboembolism or brainstem compression due to mass effect, are necessary.

KEYWORDS:

• Basilar artery
• basilar artery trunk
• endovascular treatment
• intracranial aneurysm
• stent

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of our Institutional Review Board with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

In this retrospective study, the requirement for informed consent was waived.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Sook Young Sim

Sook Young Sim, M.D., Ph.D. is a neurosurgeon and majored in cerebrovascular disease. She is also undergoing endovascular treatment as well as microsurgery for cerebrovascular diseases. She is currently an associate professor at Inje University Ilsan Paik Hospital.

Jai Ho Choi

Jai Ho Choi, M.D., Ph.D. is a neurosurgeon and majored in cerebrovascular disease. He is also undergoing endovascular treatment as well as microsurgery for cerebrovascular diseases. He is currently an associate professor at Seoul St. Mary’s Hospital, The Catholic University of Korea.

Myeong Jin Kim

Myeong Jin Kim, M.D., Ph.D. is a neurosurgeon and majored in cerebrovascular disease. He is also undergoing endovascular treatment as well as microsurgery for cerebrovascular diseases. He is currently an associate professor at Gachon University Gil Medical Center.

Yong Cheol Lim

Yong Cheol Lim, M.D. Ph.D. is a neurosurgeon and majored in cerebrovascular disease. He is also undergoing endovascular treatment as well as microsurgery for cerebrovascular diseases. He is currently a professor and the chairmen of Department of Neurosurgery, Ajou University Hospital.

Joonho Chung

Joonho Chung, M.D., Ph.D. is a neurosurgeon and majored in cerebrovascular disease. He is also undergoing endovascular treatment as well as microsurgery for cerebrovascular diseases. He is currently an associate professor at Yonsei University College of Medicine. He published many articles of various themes in the cerebrovascular field.