Clinical Study On Endovascular Treatment Of Intracranial Posterior Circulation Aneurysms

Objective To evaluate the safety and effectiveness of endovascular treatment of intracranial posterior circulation aneurysms through analyzing the clinical outcomes,perioperative neurological complications and the relationship between Hunt-Hess grading and clinical prognosis.Methods A retrospective study was carried out among patients with intracranial posterior circulation aneurysms,who received endovascular treatment at the Affiliated Hospital of Qingdao University between October 2014 and October 2017.The Hunt-Hess grading scale was applied to assess neurological status of the patients at admission.Characteristics of aneurysms,including the diameter,location and classification,were documented.And treatment methods,the degree of aneurysm conclusion and perioperative neurological complications were documented.Angiogram during follow-up was obtained through digital subtraction angiography(DSA).Clinical prognosis was evaluated by the modified Rankin Score(mRS)during the follow-up.The mRS 0-2 was defined as being independent while the mRS 3-6 was defined as being dependent or dead.Results A total of 38 posterior circulation aneurysms were identified in 38 patients in this study.There were 19 men,and the mean age was 53.6±10.4 years at the time of first treatment.The locations of aneurysms included 13(34.2%)in the intracranial segment of the vertebral artery,10(26.3%)in the basilar apex,6(15.8%)in the posterior inferior cerebellar artery,4(10.5%)in the P1 segment of the posterior cerebral artery,3(7.9%)in the superior cerebellar artery and 2(5.3%)in the basilar trunk.Of the 38 cases,31(81.6%)cases with ruptured aneurysms were presented with spontaneous subarachnoid hemorrhage(SAH)and 7(18.4%)were presented with unruptured aneurysms.There were 28(73.7%)patients in Hunt-Hess Grade 0-? and 10(26.3%)patients in Hunt-Hess Grade ?-? at first admission.A total of 39 interventional procedures were performed among the patient population,including a retreatment for a recurrent aneurysm.According to the immediate angiogram after treatment,complete occlusion was achieved in 31(81.6%)cases and incomplete occlusion in 7(18.4%)cases(including 4 residual neck,3 residual aneurysms)in the first operation.Angiographic follow-up data was obtained from 14(37.8%)patients for periods ranging from 5 to 24 months(median,6 months).One(7.1%)patient developedrecurrence at 6 months after stent-assisted coil embolization and received retreatment.Angiographic improvement was observed in 1 case and stabilization in 12 cases.Perioperative neurological complications occurred in 4(10.3%)cases,including a patient experienced acute thrombosis during the second operation.Thromboembolic incidents occurred in 3(7.7%)cases,and 2 of them were fully dependent(mRS 5)at the end of clinical follow-up.The remaining one case was diagnosed cortical blindness with complete clinical recovery in 24 hours post-operation and magnetic resonance imaging(MRI)scanning showed infarction in the bilateral occipital cortex.One patient experienced intraprocedural re-rupture of the targeted aneurysm and died 5 days after coil embolization.Clinical assessment at discharge revealed that 74.4% of the patient population were independent and 25.6% were dependent.Clinical follow-up data was obtained from 37 patients for periods ranging from 3 to 37 months(median,22 months).84.2% of the patient crowd were independent at 3 months after the treatment while 91.9% of the patient crowd at the end of clinical follow-up.During the follow-up duration,no mortality,cerebral infarction or rebleeding form the treated aneurysm was observed.Clinical outcomes in Hunt-Hess Grade 0-? group were better than Grade ?-? group at 3 months after the operation(93.1% vs 55.6%).There was significant difference in mRS scores between HuntHess Grade 0-? group and Grade ?-? group at 3 months after operation(P=0.020).Conclusion Endovascular treatment of intracranial posterior circulation aneurysms,with a low risk of perioperative complications and a good clinical outcome,is safe and effective.Patients presenting with good Hunt-Hess grade(Grade 0-?)at admission has gotten better clinical outcomes than Grade ?-? group in short-time follow-up.