Endovascular Treatment Of Posterior Circulation Complex Aneurysms

ObjectiveThe purposes were 1) to summarize the distribution, morphological characteristics and clinical manifestations of complex intracranial aneurysms located in the posterior circulation; 2) to evaluate the clinical outcome of posterior complex aneurysms treated by endovascular therapy using various techniques; 3) to guide the choose of different endovascular techniques when treating different type of aneurysms Materials and methodsFrom February 2009 to February 2015, 85 patients with cerebral complex aneurysms located in posterior circulation including proximal segments of the posterior inferior cerebellar artery, proximal posterior cerebral artery and basilar artery dissecting aneurysm were treated by endovascular therapy in our center. The technical success,the pre- and postoperative m RS,complications in hospital and follow up records were detailed recorded and analyzed. Also, clinical outcome of aneurysms located at different segments and with various morphologic characteristics was compared. ResultsAccording to location, 41.1% of the aneurysms were located in posterior cerebral artery, 30.5% in the basilar artery and 28.5% in the posterior inferior cerebellar artery. By morphological classification, 81.5% of the aneurysms were with maximum tutor size>7mm, 53.2% >10mm; 12.8% of the aneurysms were sac, 46.4% was dolichoectasia. Of the 85 patients, 53.1% was with SAH or intracranial hemorrhage, 25.1% was with ischemic stroke, 13.9% was with occipital pain, 6.9% was with dizziness and others.The technical success rate was 100%. DSA immediately after the embolization demonstrated that total occlusjon was achieved jn 39 patients, residual neck in 27, and partial occlusion in 19.Perioperative complications occurred in 11.7%(10/85) patients, 50% of which exist in the patients with basilar artery dissection aneurysms. While, during the follow up, 3 complications were observed, 66%(2/3) of which lie in the basilar artery. The aneurysms recurrence were found in 6 patients, 3 in basilar artery and 3 in posterior cerebral artery. ConclusionsEndovascular treatment for complex posterior circulation aneurysms is safe and effective; various techniques have equivalent effects for posterior inferior cerebellar artery aneurysms and stent assisted coiling has a high feasibility and safety. Moreover, the occlusion of parent artery is also safe and effective in the proximal segment of the posterior cerebral artery with perforator-rich vessels; however, treatment for the basilar artery dissection aneurysms is still rather tough, and further studies are needed to reduce complications.