Рентгенология & Радиология, 2011, XLХ 131-137

Endovascular treatment of intracranial aneurysms

M. Lilov, R. Juszkat, I. Todorov, T. Eftimov, A. Petkov

Abstract. The aim of the study was to analyze the results of the endovascular coilng and stenting as current methods for treatment of ruptured and non-ruptured intracranial aneurysms. For a period of 4 years, 132 patients – 55 (42%) male and 77 (58%) female, at average age of 50.7 years, were diagnosed with 189 intracranial aneurysms. One hundred and sixty endovascular interventions were performed, of which 127 coil embolisations, 22 stent placements and 11 reembolisations in previously embolised patients with angiographic data for recanalisation. For evaluation of the patient’s condition at admission, the Hunt & Hess scale was applied. The Fisher scale was used to classify the subarachnoid hemorrhage based on the CT-scans. Total occlusion was achieved in 93 of the 127 coiled aneurysms in our series (73.2%). Subtotal occlusion of the aneurismal sack and neck was presented in the rest 34 aneurysms (26.7%) because of their geometric characteristics. In 13 of the 55 follow-up angiographies performed, significant recanalisation was identified, which led to 11 reembolisations. We report 10 complications in the series of 160 endovascular interventions (6.25%), namely: intrainterventional aneurysm rupture – 1 case (0.63%); transient vasospasm – 3 cases (1.9%); thromboembolic complications – 5 cases (3.1%); intrainterventional in-stent thrombosis, followed by recanalisation – 1 case (0.63%). Overall mortality in our series was 3.35% (5 patients), none of the deaths directly connected to the intervention, but as a result of the poor clinical condition of the patients upon admission. Because of its minimal invasiveness and lower complication rates, the endovascular technique is gaining ground as an alternative to the surgical clipping. Nevertheless the endovascular treatment represents only a component of the healing process of patients with ruptured/unruptured cerebral aneurysms that should be carried out by a multidisciplinary team.