Endovascular treatment of complex intracranial aneurysms
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Publication date: 2018-03-26
Pol J Radiol, 2018; 83: 109-114
Complex intracranial aneurysms (CIA) are heterogenous group of intracranial vascular malformations. Due to its giant size, difficult location, broad neck, branches arising from the aneurysm, wall structure, calcification, presence of intraluminal thrombus or previous treatments it requires more careful approach. The aim of this study was to evaluate endovascular treatment results of CIA in our Department.

Material and methods:
In order to differentiate CIA from all the aneurysms, treated endovascularly in years 2008-2014, authors proposed their own qualification criteria. Additionally, subgroup of patients with CIA with simultaneous subarachnoid haemorrhage (SAH) was divided. Clinical outcomes of patients were assessed with Glasgow Outcome Scale (GOS), while radiological outcomes were assessed with Montreal Scale. Aneurysm localization, incidence of aborted procedures, intraoperative complications were also evaluated.

Internal carotid artery was the most common localization in both CIA and non-complex (nCIA) groups. Incidence of aborted procedures was significantly higher in CIA group than in nCIA (25% vs. 7%; p < 0.01). CIA group had worse Montreal scores then nCIA group (1.90 vs. 1.49; p < 0.01). Clinical outcome in GOS scale in patients with SAH and CIA was significantly worse than in SAH and nCIA (2.86 vs. 4.06; p = 0.04).

To conclude, proposed criteria of CIA should be taken into consideration during diagnosis and qualification to invasive treatment. Classifying aneurysm as CIA is related to greater possibility of aborting endovascular procedure due to technical difficulties.

Wiebers DO, Whisnant JP, Huston J 3rd, et al. International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003; 362: 103-110.
Pierot L, Wakhloo AK. Endovascular treatment of intracranial aneurysms: current status. Stroke 2013; 44: 2046-2054.
Kivipelto L, Niemelä M, Meling T, et al. Bypass surgery for complex middle cerebral artery aneurysms: impact of the exact location in the MCA tree. J Neurosurg 2014; 120: 398-408.
Yang K, Ahn JS, Park JC, et al. The efficacy of bypass surgery using a short interposition graft for the treatment of intracranial complex aneurysm. World Neurosurg 2015; 83: 197-202.
Abla AA, Lawton MT. Anterior cerebral artery bypass for complex aneurysms: an experience with intracranial-intracranial reconstruction and review of bypass options. J Neurosurg 2014; 120: 1364-1377.
Qureshi AI, Abou-Chebl A, Jovin TG. Qualification Requirements for Performing Neurointerventional Procedures: A Report of the Practice Guidelines Committee of the American Society of Neuroimaging and the Society of Vascular and Interventional Neurology. J Neuroimaging 2008; 18: 433-447.
Seibert B, Tummala RP, Chow R, et al. Intracranial Aneurysms: Review of Current Treatment Options and Outcomes. Front Neurol 2011; 2: 45.
Fernandes ST, Alves RV, Dória-Netto HL, et al. Treatment of complex intracranial aneurysm: Case report of the simultaneous use of endovascular and microsurgical techniques. Surg Neurol Int 2016; 7: 1060-1064.
Hanel RA, Spetzler RF. Surgical treatment of complex intracranial aneurysms. Neurosurgery 2008; 62: 289-99.
Barrow DL, Cawley C. Surgical management of complex intracranial aneurysms. Neurol India 2004; 52: 156-162.
Andaluz N, Zuccarello M. Treatment Strategies for Complex Intracranial Aneurysms: Review of a 12-Year Experience at the University of Cincinnati. Skull Base 2011; 21: 233-242.
Shi X, Qian H, Fang T, e al. Management of complex intracranial aneurysms with bypass surgery: a technique application and experience in 93 patients. Neurosurg Rev 2015; 38: 109-119.
Abdulrauf SI, Urquiaga JF, Patel R, et al. Awake High-Flow Extracranial to Intracranial (HFEC-IC) Bypass for Complex Cerebral Aneurysms: Institutional Clinical Trial Results. World Neurosurg 2017; https://doi.org/10.1016/j.wneu....
Labeyrie PE, Gory B, Aguilar-Perez M, et al. The pCONus Device for Treatment of Complex Wide-Neck Anterior Communicating Artery Aneurysms. World Neurosurg 2017; http://dx.doi.org/10.1016/j.wn....
Jeon HJ, Kim BM, Kim DJ, et al. Combination of Multicatheter Plus Stent or Balloon for Treatment of Complex Aneurysms. AJNR Am J Neuroradiol 2016; 37: 311-316.
Esposito G, Regli L. Surgical decision-making for managing complex intracranial aneurysms. Acta Neurochir Suppl 2014; 119: 3-11.
Suarez JI, Tarr RW, Selman WR. Aneurysmal Subarachnoid Hemorrhage. N Engl J Med 2006; 354: 387-396.
Ha SW, Jang SJ. Clinical Analysis of Giant Intracranial Aneurysms with Endovascular Embolization. J Cerebrovasc Endovasc Neurosurg 2012; 14: 22-28.
Tykocki T, Czyż M, Machaj M, et al. Comparison of the timing of intervention and treatment modality of poor-grade aneurysmal subarachnoid hemorrhage. Br J Neurosurg 2017; doi: https://doi.org/10.1080/026886....
Petridis AK, Kamp MA, Cornelius JF, et al. Aneurysmal Subarachnoid Hemorrhage. Dtsch Arztebl Int 2017; 114: 226-236.
Breu AK, Hauser TK, Ebner FH, et al. Morphologic and Clinical Outcome of Intracranial Aneurysms after Treatment Using Flow Diverter Devices: Mid-Term Follow-Up. Radiol Res Pract 2016; 2016: 2187275.
Jin SC, Kwon DH, Song Y, et al. Multimodal Treatment for Complex Intracranial Aneurysms: Clinical Research. J Korean Neurosurg Soc 2008; 44: 314-319.
Ismail Alhothi A, Qi T, Guo S, et al. Neuroform stent-assisted coil embolization: a new treatment strategy for complex intracranial aneurysms. Results of medium length follow-up. Neurol Neurochir Pol 2010; 44: 366-374.
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