Background:
Due to a high surgical risk, endovascular repair of the basilar artery (BA) aneurysm is considered the primary option for most of the cases. However, procedure related complications, clinical outcome and rate of recurrence in BA bifurcation aneurysms are not specifically addressed. Objectives: is to describe the incidence of endovascular procedure related complications, recurrence of aneurysm and long-term clinical outcome of BA aneurysm.
Methods:
Consecutive patients who underwent endovascular repair of BA bifurcation aneurysm were enrolled from 2007 to 2010. Patient’s demographics including the Hunt & Hess (H&H) grade, Fished scale, and size of aneurysm were collected. Complications including aneurysm rupture, intracranial hemorrhage or thromboembolic event were recorded. Additionally, 90-days outcome measurement was obtained using Glasgow Outcome Scale (GOS).
Results:
36 patients with a mean age of 50 plus-minus 14 years required 48 successful procedures to treat 36 BA bifurcation aneurysms. Ruptured aneurysm was present in 20 cases (H&H I in 6, II in 4, III in 4 and IV in 6). 30 patients (83%) had wide neck aneurysm, 25 (69%) of which required stent in order to secure the aneurysm. There was no intraoperative rupture of aneurysm or thromboembolic event. However, one patient developed diplopia with visual incoordination on day one and other developed diplopia due to a small pontine stroke while stopping clopidogrel on post operative day 30 of stent-assisted repair. Both patients recovered completely with no disability. Ten patients (28%) had recurrence of aneurysm and required subsequent procedure. In recurrent aneurysms, repeat procedures had no negative impact on the clinical outcome. One patient died (GOS 1) who initially presented with H&H IV and never recovered. Good outcome was observed in 32 (89%) patients (GOS 5 in 31, GOS 4 in 1) including all unruptured cases and 3 of 5 ruptured BA aneurysm patients who presented with H&H of IV. Poor outcome was observed in 3 (8%) patients (GOS 3 in 3, 2 of which presented with H&H IV).
Conclusion:
Endovascular repair of the BA bifurcation aneurysms are associated with good clinical outcome despite requirement of multiple procedures to complete the treatment. However, the recurrence of aneurysm is very high. Therefore, a very close angiographic follow-up is necessary.
An autopsy report of basilar artery aneurysm flow diversion complicated by postoperative day 3 hemorrhage from vessel rupture
