Clinical Study Of Endovascular Treatment For Tiny Intracranial Aneurysms

Objective: To summarize the clinical experience of endovascular treatment for tiny intracranial aneurysms and evaluate the safety and efficacy of endovascular treatment for patients with tiny intracranial aneurysms.Methods: We retrospectively analyzed the clinical and image data of 92 patients with tiny intracranial aneurysms treated by embolization from Jan.01,2014 to Jun.31,2017 in department of Neurosugery,Yijishan Hospital,Wannan Medical College.Statistical analysis of the risk factors affecting surgery-related complications,recurrence rates and Patients' clinical outcomes.Results: A total of 92 patients with intracranial microaneurysms were included,including 9 unruptured aneurysms.Of the 92 patients,41 were males and 51 were females.The ratio of male to female was 1:1.27;the age ranged from 23 to 77 years and the average age was(55.1±11.6)years.Preoperative Hunt-Hess classification: Grade 0 in 9 cases,Grade 1 in 29 cases,Grade 2 in 26 cases,Grade 3 in 18 cases,and Grade 4 in 10 cases.There were 34 cases of anterior communicating artery aneurysms,21 cases of posterior communicating aneurysms,10 cases of ophthalmic artery aneurysms,8 cases of middle cerebral artery aneurysm,4 cases of anterior cerebral artery A1 aneurysm,6 cases of periorbital aneurysm,and prechoroidal artery There were 4 cases of tumor,2 cases of posterior inferior cerebellar aneurysm and 2 cases of aneurysm of internal carotid artery bifurcation,and 1 case of basilar artery aneurysm.Intravascular treatment was successfully performed in all patients.There were 74 cases of aneurysm embolization,8 cases of neck remnants,and 10 cases of embolization.Among them,45 cases were treated with simple coil embolization,and 35 cases were completely embolized.There were 7 cases with residual neck and 3 cases with partial embolization.There were 47 cases with stent embolization,39 cases with complete embolization,1 cases with residual neck,7 cases with partial embolization.Surgical related complications: rupture of the aneurysm in 2 cases,1 case of death due to postoperative diffuse brain swelling;acute thrombosis in 3 cases,cerebral vasospasm in 2 cases,distal artery-occluded artery occlusion in 1 case.There were 3 patients with postoperative cerebral infarction,1 of whom had hemiparalysis due to one side of the limb.Follow-up angiography followed 50 patients and 9 patients had recurrence,including 7 cases of embolization,2 cases of stent-assisted embolization,and no rebleeding.After statistical analysis,there was no significant difference in the rate of complete aneurysm embolization immediately after stent-assisted embolization and simple coil embolization.The incidence of thrombus and postoperative cerebral infarction in stent-assisted coil embolization was higher than that of simple coil embolization.The difference was statistically significant.Preoperative Hunt-Hess grade IV-V patients had worse clinical outcomes than patients with grade 0-III,with statistically significant differences.After DSA follow-up,it was found that stent-assisted embolization could reduce the postoperative recurrence rate of microaneurysms,and the difference was statistically significant.Conclusion: Intravascular treatment of intracranial microaneurysms is safe and effective.Compared with simple coil embolization,stent-assisted embolization can reduce the recurrence rate of aneurysms in patients with intracranial microaneurysms.However,the risk of acute thrombosis and the incidence of postoperative ischemic events are relatively high.The preoperative Hunt-Hess grade is an independent risk factor that affects the prognosis of patients.The higher the grade,the worse the prognosis.For patients with small aneurysms,individualized treatment according to the specific conditions of patients,and to strengthen the follow-up of cerebral angiography can benefit patients.