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. 2020 Dec;30(4):817-826.
doi: 10.1007/s00062-019-00835-8. Epub 2019 Nov 6.

Endovascular Treatment of Small Ruptured Intracranial Aneurysms (<5 mm) : Long-term Clinical and Angiographic Outcomes and Related Predictors

Fei Peng  1   2   3 , Xin Feng  4   5 , Xin Tong  1   2   3 , Baorui Zhang  1   2   3 , Luyao Wang  1   2   3 , Erkang Guo  1   2   3 , Peng Qi  4 , Jun Lu  4 , Zhongxue Wu  1   2 , Daming Wang  6   7 , Aihua Liu  8   9   10
Affiliations

Endovascular Treatment of Small Ruptured Intracranial Aneurysms (<5 mm) : Long-term Clinical and Angiographic Outcomes and Related Predictors

Fei Peng et al. Clin Neuroradiol. 2020 Dec.

Abstract

Purpose: To investigate the long-term clinical and angiographic outcomes and their related predictors in endovascular treatment (EVT) of small (<5 mm) ruptured intracranial aneurysms (SRA).

Methods: The study retrospectively reviewed patients with SRAs who underwent EVT between September 2011 and December 2016 in two Chinese stroke centers. Medical charts and telephone call follow-up were used to identify the overall unfavorable clinical outcomes (OUCO, modified Rankin score ≤2) and any recanalization or retreatment. The independent predictors of OUCO and recanalization were studied using univariate and multivariate analyses. Multivariate Cox proportional hazards models were used to identify the predictors of retreatment.

Results: In this study 272 SRAs were included with a median follow-up period of 5.0 years (interquartile range 3.5-6.5 years) and 231 patients with over 1171 aneurysm-years were contacted. Among these, OUCO, recanalization, and retreatment occurred in 20 (7.4%), 24 (12.8%), and 11 (7.1%) patients, respectively. Aneurysms accompanied by parent vessel stenosis (AAPVS), high Hunt-Hess grade, high Fisher grade, and intraoperative thrombogenesis in the parent artery (ITPA) were the independent predictors of OUCO. A wide neck was found to be a predictor of recanalization. The 11 retreatments included 1 case of surgical clipping, 6 cases of coiling, and 4 cases of stent-assisted coiling. A wide neck and AAPVS were the related predictors.

Conclusion: The present study demonstrated relatively favorable clinical and angiographic outcomes in EVT of SRAs in long-term follow-up of up to 5 years. THE AAPVS, as a morphological indicator of the parent artery for both OUCO and retreatment, needs further validation.

Keywords: Angiography; Intracranial aneurysms; Retreatment; Risk factors; Treatment.

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Conflict of interest statement

F. Peng, X. Feng, X. Tong, B. Zhang, L. Wang, E. Guo, P. Qi, J. Lu, Z. Wu, D. Wang and A. Liu declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a Kaplan-Meier curve of the survival function for retreatment. Mean survival: 49.4 ± 31.2 months. b Kaplan-Meier curve of the survival function comparing AAPVS none, mild, severe, which demonstrate the relationship between AAPVS and retreatment (P = 0.006)
See this image and copyright information in PMC

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