Endovascular treatment of intracranial aneurysms by interventional neurologists: first year single-center experience

Abstract

Background: Endovascular embolization of ruptured intracranial aneurysms provides an adequate treatment and long-term results with less morbidity and mortality (M&M) compared with surgical treatment. Since the last decade more and more ruptured and unruptured intracranial aneurysms (IA) undergo endovascular embolization in the United States. We present our experience of the initial one year periprocedural M&M at Paul L. Foster School of Medicine (PLFSM), Texas Tech Health Science Center (TTUHSC) in El Paso, Texas.

Methods: Demographics, technical aspects of the endovascular procedure and clinical assessment, including several commonly used scales to assess the severity in case of subarachnoid hemorrhage were collected. Perioperative complications were classified as minor and major. All data is prospectively collected in a local database. Only endovascular treated aneurysms were included in the study.

Results: During the first year of opening of the interventional neurology program at our school of medicine (March 2011 and March 2012), a total 45 ruptured and unruptured intracranial aneurysms were treated with endovascular embolization. Two thirds of the patients (n = 27) presented with a ruptured IA. Within those with a ruptured aneurysm, the most median Hunt and Hess grade was 3. By large the vast majority of treated IA were in the anterior circulation and more than half measured 7-12 mm. Only three unruptured IA were <7 mm (average 5.5 mm). Complications occurred in seven patients (15%), four of them were minor without any clinical sequelae. The remaining three included; intracranial dissection and aneurysmal rupture resulting in both hemorrhagic or ischemic stroke and death in only one patient.

Conclusion: The first year experience of interventional neurology services at Paul L. Foster School of Medicine in El Paso, Texas demonstrates successful treatments with comparable national rates of morbidity and mortality.

Abbreviations: ACAAnterior cerebral arteryAcommAnterior communicating arteryESNEndovascular surgical neuroradiologyH&HHunt and Hess scaleIAIntracranial aneurysmICAInternal carotid arteryMCAMiddle cerebral arteryM&MMorbidity and mortalitySAHSubarachnoid hemorrhagePcommPosterior communicating arteryPLFSMPaul L. Foster School of MedicineTTUHSCTexas Tech University Health Science CenterVAVertebral artery.

Keywords: aneurysm coiling; cerebral angiography; endovascular treatment; intracranial aneurysm; subarachnoid hemorrhage.