| Objective:Retrospective analysis of endovascular therapy in our department for the treatment of wide-necked aneurysms at the basilar apex arteries,to explore its safety and efficacy.Method:In this study,the case data of patients undergoing intravascular intervention therapy for basilar apex artery aneurysm in the Neurovascular Diseases Department of the First Hospital of Jilin University from August 2016 to September 2021,and a total of 36 cases that met the conditions were collected.Their general conditions（including age,sex,clinical manifestations of onset,etc.）,imaging manifestations,surgical effects and long-term prognosis were studied and analyzed.Result:All 36 patients were successfully treated with endovascular therapy,ranging in age from 41 to 73 years,with an average of 57.7 years.Of these,9 were male（25%,9/36）and 27 were female（75%,27/36）.The main manifestations of the disease: 18 cases were manifested as headache,nausea,and vomiting,4 cases were presented with dilated pupils and ptosis,3 cases were manifested by sudden unconsciousness,2 cases were presented with sudden dizziness with limb dysfunction,and 9 cases were asymptomatic patients found by physical examination,including 16 cases of Hunt-Hess Class I,15 cases of Hunt-Hess Level II,and 5 cases of Hunt-Hess Grade III.The 36 aneurysms included 15 unruptured aneurysms and 21 ruptured aneurysms.All 36 patients had a definitive diagnosis with preoperative CTA,MRA,or DSA examination.Among the 36 patients,12 cases had other aneurysms,including 7 cases of internal carotid artery aneurysms（3 cases of ophthalmic sement aneurysms and 4 cases of posterior communicating artery aneurysms）,2 cases of middle cerebral aneurysms,2 cases of anterior communicating artery aneurysms,and 1 case of multiple intracranial aneurysms;in addition,1 case of Moyamoya disease and 7cases of severe arterial stenosis or occlusion were combined;21 cases of patients with ruptured aneurysms all showed different degrees of subarachnoid hemorrhage（SAH）,of which 3 patients had ventricular hemorrhage.According to the maximum diameter of the aneurysm,it is divided into three categories,the micro aneurysms are smaller than 3 mm,small aneurysms are 3 to 10 mm,and large aneurysms are greater than 10 mm.Among them,there were 6 cases of micro aneurysms,23 cases of small aneurysms,and 7 cases of large aneurysms.Among them,5 patients were elected to undergo embolization by double catheterization,27 patients were treated with single-stent-assisted embolism,and4 patients were treated with Y-stent-assisted embolism.Immediate postoperative embolization of aneurysms reached Raymond I level 21（58.3%）,Raymond II level 14（38.9%）,and Raymond III（2.8%）.Complicated by cerebrovascular spasm 1 case,basal artery apical syndrome 1 case,no deaths.Of the 32 patients who underwent the DSA test at 6 to 12 months postoperatively,4 patients had a recurrence（12.5%）.At discharge,the score was based on the modified Rankin Scale（m RS）: 23 cases with 0-1 points,9 cases with 2 points,3 cases with 3points,and 4 points with 1 case.Follow-up at 6 to 24 months postoperatively,based on modified Rankin Scale（m RS）scores: 0-1 point 34 cases,2 points 1case,death 1 case.Conclusion:Endovascular therapy is safe and effective for wide-necked aneurysms at the basilar apex arteries,and stent-assisted embolization is an important technique for endovascular therapy.Ischemic complications are common in complications associated with endovascular therapy and require early prevention,timely detection and symptomatic treatment. |
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