Treatment of Ruptured Intracranial Aneurysms: Comparison of Stenting and Balloon Remodeling

Abstract BACKGROUND: Stent-assisted coiling (SAC) and balloon-assisted coiling (BAC) are 2 well-established techniques for the treatment of complex and wide-necked intracranial aneurysms. Most clinicians are reluctant to perform SAC in the setting of subarachnoid hemorrhage because of the need for dual antiplatelet therapy. OBJECTIVE: To compare the safety and efficacy of SAC and BAC in acutely ruptured complex and wide-necked aneurysms. METHODS: Forty-four patients underwent SAC and 40 underwent BAC. Patients treated with SAC received antiplatelet medications. Perioperative adverse events and outcomes at follow-up (mean, 7.4 months) were retrospectively studied. RESULTS: The 2 groups were statistically comparable with respect to all baseline characteristics except for older age in SAC patients (65.6 vs 56.5 years; P = .009). A higher proportion of SAC patients also had poor Hunt and Hess grades (III-V; 70.5% vs 55%; P = .l4). Hemorrhagic, thromboembolic, and overall procedural complications occurred in 6.8%, 11.4%, and 18.2% of the SAC group vs 2.5%, 7.5%, and 10% of the BAC group, respectively (P = .5, P = .6, P = .3, respectively). Favorable outcomes (modified Rankin Scale score 0-2) at follow-up were seen in 61.0% of the SAC group vs 77% of the BAC group (P = .1). In multivariable analysis, after controlling for differences in baseline characteristics, the type of treatment was not a predictor of procedural complications or clinical outcome. CONCLUSION: In this study, procedural complications and clinical outcomes did not differ significantly between SAC and BAC in patients with acutely ruptured aneurysms. SAC may be an acceptable alternative to BAC for complex aneurysms in the acute phase of subarachnoid hemorrhage.

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Endovascular Treatment of Intracranial Aneurysms in the Elderly: Single-Center Experience in 63 Consecutive Patients

Neurosurgery ◽

10.1227/01.neu.0000185583.25420.df ◽

2005 ◽

Vol 57 (6) ◽

pp. 1096-1102 ◽

Cited By ~ 71

Author(s):

YiLing Cai ◽

Laurent Spelle ◽

Huan Wang ◽

Michel Piotin ◽

Charbel Mounayer ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Endovascular Procedures ◽

The Elderly ◽

High Grade ◽

Single Center ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms

Abstract OBJECTIVE: With a globally aging population, it is imperative to develop specific treatment strategies for intracranial aneurysms in the elderly. However, the optimal management of intracranial aneurysms in the elderly remains controversial, particularly for the unruptured aneurysms. Although endovascular treatment is increasingly being used for the management of aneurysms, large endovascular series in the elderly population are relatively lacking, especially with regard to the unruptured aneurysms. We present our single-center endovascular experience in treating intracranial aneurysms in 63 consecutive patients 70 years of age and older. METHODS: Between November 1998 and December 2003, among a total of 990 patients with intracranial aneurysms treated endovascularly at our center, 63 patients (6%) were 70 years of age or older. Forty-one patients presented with subarachnoid hemorrhage (SAH), and 22 presented with symptomatic unruptured aneurysms. A total of 84 aneurysms were detected in these 63 patients. Only those responsible for either the subarachnoid hemorrhage or clinical symptoms (68 aneurysms) were treated. The aneurysm characteristics, endovascular procedures and techniques, angiographic and clinical outcomes, and complications were reviewed. RESULTS: Selective embolization failed in three aneurysms (4%). In the remaining 65 aneurysms, complete occlusion was achieved in 33 aneurysms (51%), neck remnant was observed in 17 aneurysms (27%), and residual aneurysmal filling was observed in six aneurysms (9%). Parent vessel occlusion was used in the treatment of nine aneurysms (13%). Thirteen procedure-related complications occurred (19%), six of which resulted in clinical complications (9%). Nine deaths (14%) occurred; three (5%) were directly related to the endovascular procedures, and six (9%) were related to the medical complications of SAH. The remaining 54 patients had a mean clinical follow-up time of 13 months (range, 1–47 mo). Ninety-one percent (20 out of 22) of the patients with unruptured aneurysms and 89% (25/28) of the patients with low-grade (Hunt and Hess Grade I and II) ruptured aneurysms achieved excellent outcomes (modified Rankin Scale score, 0–1), whereas 77% (10 out of 13) of the patients with high-grade (Hunt and Hess Grade ≥ III) ruptured aneurysms either died or had very poor outcomes (modified Rankin Scale score, 4–5). Angiographic follow-up (mean, 11 mo; range, 3–38 mo) was obtained in 34 of the 54 living patients (63%). Two aneurysms demonstrated minor changes that required no further treatment (5%). Five aneurysms showed major recurrences (17%), all of which were successfully retreated endovascularly. CONCLUSION: The elderly patients should merit strong consideration for endovascular treatment of both ruptured and symptomatic unruptured intracranial aneurysms. However, in elderly patients with high-grade subarachnoid hemorrhage, morbidity and mortality rates remain high.

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Comprehensive review of imaging of intracranial aneurysms and angiographically negative subarachnoid hemorrhage

Neurosurgical FOCUS ◽

10.3171/2019.9.focus19653 ◽

2019 ◽

Vol 47 (6) ◽

pp. E20 ◽

Cited By ~ 4

Author(s):

Brian M. Howard ◽

Ranliang Hu ◽

Jack W. Barrow ◽

Daniel L. Barrow

Keyword(s):

Subarachnoid Hemorrhage ◽

Best Practices ◽

Intracranial Aneurysms ◽

Vascular Lesion ◽

Reference Standard ◽

Unruptured Intracranial Aneurysm ◽

Imaging Protocols ◽

Ruptured Intracranial Aneurysms

Intracranial aneurysms confer the risk of subarachnoid hemorrhage (SAH), a potentially devastating condition, though most aneurysms will remain asymptomatic for the lifetime of the patient. Imaging is critical to all stages of patient care for those who harbor an unruptured intracranial aneurysm (UIA), including to establish the diagnosis, to determine therapeutic options, to undertake surveillance in patients who elect not to undergo treatment or whose aneurysm(s) portends such a low risk that treatment is not indicated, and to perform follow-up after treatment. Neuroimaging is equally as important in patients who suffer an SAH. DSA remains the reference standard for imaging of intracranial aneurysms due to its high spatial and temporal resolution. As noninvasive imaging technology, such as CTA and MRA, improves, the diagnostic accuracy of such tests continues to increasingly approximate that of DSA. In cases of angiographically negative SAH, imaging protocols are necessary not only for diagnosis but also to search for an initially occult vascular lesion, such as a thrombosed, ruptured aneurysm that might be detected in a delayed fashion. Given the crucial role of neuroimaging in all aspects of care for patients with UIAs and SAH, it is incumbent on those who care for these patients, including cerebrovascular neurosurgeons, interventional neurologists and neuroradiologists, and diagnostic radiologists and neurointensivists, to understand the role of imaging in this disease and how individual members of the multispecialty team use imaging to ensure best practices to deliver cutting-edge care to these often complex cases. This review expounds on the role of imaging in the management of UIAs and ruptured intracranial aneurysms and in the workup of angiographically negative subarachnoid hemorrhage.

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Safety and Efficacy of Endovascular Embolization of Ruptured Intracranial Aneurysms within 72 hours of Subarachnoid Hemorrhage

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1731752 ◽

2021 ◽

Author(s):

Xin-Yu Li ◽

Cong-Hui Li ◽

Ji-Wei Wang ◽

Jian-Feng Liu ◽

Hui Li ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Aneurysms ◽

Endovascular Embolization ◽

Safety And Efficacy ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Significant Difference ◽

Group A ◽

Group B ◽

Ruptured Intracranial Aneurysms

Abstract Purpose The purpose of the study was to investigate the safety and efficacy of endovascular embolization of ruptured intracranial aneurysms within 72 hours of subarachnoid hemorrhage (SAH). Materials and methods Patients with intracranial aneurysms treated with embolization were divided into group A (n = 277), patients with ruptured aneurysms treated within 72 hours of SAH; group B (n = 138), patients with ruptured aneurysms treated beyond 72 hours; and group C (n = 93), patients with unruptured aneurysms. Results Embolization was successful in all but four patients (99.2%). The periprocedural complication rate was 36.2% in group B, significantly (p < 0.05) greater than that in group A (24.5%) or group C (11.8%). The rebleeding rate was 9.7% (6/62 patients) in groups A and B after embolization and only 0.3% (1/346 patients) in aneurysms with total or subtotal occlusion. Of these three groups of patients, 69.7% in group A, 58.7% in group B, and 76.3% in group C achieved Glasgow Outcome Scale (GOS) score of 5 or modified Rankin Scale (mRS) score of 0– to 1 at discharge. A significant difference (p < 0.05) existed in the clinical outcome between the three groups. The percentages of patients without deficits (GOS 5 or mRS 0–1) and slight disability (mRS 2) were 80.2% in group A, 81.2% in group B, and 96.7% in group C. The mortality rate was 4.3% (12/277 patients) in group A and 7.2% (10/138 patients) in group B with no significant (p = 0.21) difference. Follow-up was performed at 3 to 54 months (mean 23.2), and the recanalization rate was 28.6% (32/112 patients) in group A, 22.4% (11/49 patients) in group B, and 28.6% (16/56 patients) in group C, with no significant differences (p = 0.15). Hydrocephalus occurred in 30.5% (39/128 patients) in group B, which was significantly (p < 0.01) greater than that in group A (9.4%) or group C (2.2%). Conclusion Early embolization of ruptured cerebral aneurysms within 72 hours of rupture is safe and effective and can significantly decrease periprocedural complications compared with management beyond 72 hours. Timely management of cisternal and ventricular blood can reduce hydrocephalus incidence and improve prognosis.

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Comparison of stent-assisted and no-stent coil embolization for safety and effectiveness in the treatment of ruptured intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/2019.5.jns19988 ◽

2020 ◽

Vol 133 (3) ◽

pp. 814-820 ◽

Cited By ~ 2

Author(s):

Haewon Roh ◽

Junwon Kim ◽

Heejin Bae ◽

Kyuha Chong ◽

Jong Hyun Kim ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

High Risk ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Viable Option ◽

Safety And Efficacy ◽

Ruptured Aneurysms ◽

Hemorrhagic Complications ◽

Acute Subarachnoid Hemorrhage ◽

Ruptured Intracranial Aneurysms

OBJECTIVEThe safety of the stent-assisted coil embolization (SAC) technique for acutely ruptured aneurysms has not been established yet. SAC is believed to be associated with a high risk of thromboembolic and hemorrhagic complications in acute subarachnoid hemorrhage (SAH). The aim of this study was to evaluate the safety and efficacy of the SAC technique in the setting of acutely ruptured aneurysm.METHODSA total of 102 patients who received endovascular treatment for acute SAH between January 2011 and December 2017 were enrolled. The SAC technique was performed in 38 of these patients, whereas the no-stent coil embolization (NSC) technique was performed in 64. The safety and efficacy of the SAC technique in acute SAH was evaluated as compared with the NSC technique by retrospective analysis of radiological and clinical outcomes.RESULTSThere were no significant differences in clinical or angiographic outcomes between the SAC and NSC techniques in patients with acute SAH. The rate of ventriculostomy-related hemorrhagic complications was higher in the SAC group than that in the NSC group (63.6% vs 12.5%; OR 12.25, 95% CI 1.78–83.94, p = 0.01). However, all these complications were asymptomatic and so small that they were only able to be diagnosed with imaging.CONCLUSIONSRuptured wide-necked aneurysms could be effectively and safely treated with the SAC technique, which showed clinical and angiographic outcomes similar to those of the NSC technique. Hence, the SAC technique with dual-antiplatelet drugs may be a viable option even in acute SAH.

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The safety and outcomes of acutely ruptured intracranial aneurysms with incomplete occlusion after coiling: a case-control study

BMC Neurology ◽

10.1186/s12883-020-01991-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jianhe Yue ◽

Yuan Xie ◽

Xiaolin Zhang ◽

Yongxiang Jiang ◽

Weifu Chen ◽

...

Keyword(s):

Recurrence Rate ◽

Intracranial Aneurysms ◽

Multivariable Analysis ◽

Complete Occlusion ◽

Significant Difference ◽

Complications Rate ◽

Progressive Occlusion ◽

Incomplete Occlusion ◽

Ruptured Intracranial Aneurysms

Abstract Background Incomplete aneurysmal occlusion is a common feature of immediate posttreatment angiography. The safety and outcomes of acutely ruptured intracranial aneurysms (RIAs) with incomplete occlusion after stent-assisted coiling (SAC) and no-stent coiling (NSC) have not been well clarified. Progressive occlusion of stents can promote the complete occlusion of intracranial aneurysms (IAs), but it remains to be determined if progressive occlusion in acutely RIAs with incomplete occlusion after coiling may be enhanced by protective stenting. This study aimed to evaluate the safety and outcomes of those aneurysms after SAC and NSC; And to discover whether the stents can promote progressive aneurysm occlusion in such lesions or not. Methods We reviewed 199 patients with acutely RIAs underwent endovascular coiling and developed incomplete occlusion in the past seven years. The patients’ clinical and imaging information were recorded and analyzed. Univariate and multivariate analyses were performed to determine the association of recurrence rate with potential risk factors. Results SAC group had wider aneurysms neck (3.471 mm vs 2.830 mm, P = 0.009) and smaller dome-to-neck ratio (1.536 vs 2.111, P = 0.001) than in NSC group. There was no significant difference between the two groups in total procedure-related complications rate (31.7% vs 23.5%, P = 0.195), procedure-related mortality (6.9% vs 2.0%, P = 0.170) and modified Rankin Scale (mRS) score at 6-month follow-up (P > 0.05). However, SAC group had significantly higher ischemic complications rate (21.8% vs 8.2%, P = 0.007) and complete occlusion rate (65.6% vs 48.3%, P = 0.020), and lower recurrence rate (15.6% vs 28.1%, P = 0.042) than NSC group based on 6-month follow-up angiograms. Additionally, Multivariable analysis showed NSC was an independent risk factor for aneurysm recurrence (Odds Ratio [OR]: 4.061; P = 0.018). Conclusions Acutely RIAs with incomplete occlusion after SAC is associated with higher complications rate and mortality, but has an acceptable safety profile and similar clinical outcome compared to NSC, as well as gives patients superior angiography outcome by progressive occlusion of stents.

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Treatment of Ruptured Intracranial Aneurysms With the Pipeline Embolization Device

Neurosurgery ◽

10.1227/neu.0000000000000586 ◽

2014 ◽

Vol 76 (2) ◽

pp. 165-172 ◽

Cited By ~ 46

Author(s):

Nohra Chalouhi ◽

Mario Zanaty ◽

Alex Whiting ◽

Stavropoula Tjoumakaris ◽

David Hasan ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Case Series ◽

Invasive Procedure ◽

Complication Rates ◽

Pipeline Embolization Device ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Effective Option ◽

Ruptured Intracranial Aneurysms

ABSTRACT BACKGROUND: The pipeline embolization device (PED) has been used for treatment of unruptured aneurysms. Little is known about the use of the PED in ruptured aneurysms. OBJECTIVE: To assess the safety and efficacy of the PED in ruptured intracranial aneurysms. METHODS: This is a case series with prospective data collection on 20 patients with freshly ruptured aneurysms who were treated with PED (with or without adjunctive coiling) at 2 cerebrovascular centers. Patients were loaded with aspirin and clopidogrel or received an infusion of tirofiban intraoperatively. RESULTS: Hunt and Hess grades were I in 7 patients (35%), II in 9 (45%), and III in 4 (20%). The mean duration from hemorrhage to PED placement was 7 ± 7.0 days. A single device was used in all but 1 patient (95%). The procedure was staged in 20%. There was only 1 complication (5%); this was a fatal intraoperative aneurysm dome rupture that occurred during adjunctive coil deployment. Adjunctive coiling was used in 30%. No patient required an invasive procedure after PED placement. Follow-up angiography (mean, 5.3 ± 4.2 months; range, 2-12 months) showed 100% occlusion in 12 (80%) and incomplete occlusion in 3 patients (20%). At latest follow-up, 19 patients achieved a favorable outcome (modified rankin scale 0–2). CONCLUSION: In our preliminary experience, treatment of ruptured aneurysms with the PED was associated with low complication rates, high occlusion rates, and favorable outcomes. These findings suggest that PED may be a safe and effective option for patients with favorable Hunt and Hess grades and aneurysms difficult to treat with conventional methods.

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Matched Comparison of Flow Diversion and Coiling in Small, Noncomplex Intracranial Aneurysms

Neurosurgery ◽

10.1093/neuros/nyw070 ◽

2017 ◽

Vol 81 (1) ◽

pp. 92-97 ◽

Cited By ~ 11

Author(s):

Nohra Chalouhi ◽

Badih Daou ◽

Guilherme Barros ◽

Robert M. Starke ◽

Ameet Chitale ◽

...

Keyword(s):

Multivariate Analysis ◽

Intracranial Aneurysms ◽

Flow Diversion ◽

First Line ◽

Complex Aneurysms ◽

Aneurysm Size ◽

Aneurysm Morphology ◽

Baseline Characteristics ◽

Matched Comparison

Abstract BACKGROUND: Flow diversion is typically reserved for large, giant, or morphologically complex aneurysms. Coiling remains a first-line treatment for small, morphologically simple aneurysms. OBJECTIVE: To compare coiling and flow diversion in small, uncomplicated intracranial aneurysms (typically amenable to coiling). METHODS: Forty patients treated with the pipeline embolization device (PED) for small (<10 mm), morphologically simple aneurysms that would have also been amenable to coiling were identified. These patients were matched in a 1:1 fashion with 40 patients with comparable aneurysms treated with coiling. Matching was based on age, gender, aneurysm size, and aneurysm morphology. RESULTS: The 2 groups were comparable with regard to baseline characteristics including age, gender, and aneurysm size. The complication rate did not differ between the 2 groups (2.5% with coiling vs 5% with PED; P = .6). Multivariate analysis did not identify any predictor of complications. Complete occlusion (100%) at follow-up was significantly higher in patients treated with PED (70%) than coiling (47.5%, P = .04). In multivariate analysis, treatment with PED predicted aneurysm obliteration (P = .04). A significantly higher proportion of coiled patients (32.5%) required retreatment compared with flow diversion (5%, P = .003). In multivariate analysis, coiling predicted retreatment (P = .006). All patients achieved a favorable outcome (modified Rankin Scale: 0-2) regardless of group. CONCLUSION: This matched analysis suggests that flow diversion provides higher occlusion rates, lower retreatment rates, and no additional morbidity compared with coiling in small, simple aneurysms amenable to both techniques. These results suggest a potential benefit for flow diversion over coiling even in small, uncomplicated aneurysms.

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A Review of Size and Location of Ruptured Intracranial Aneurysms

Neurosurgery ◽

10.1097/00006123-200112000-00006 ◽

2001 ◽

Vol 49 (6) ◽

pp. 1322-1326 ◽

Cited By ~ 169

Author(s):

Thomas R. Forget ◽

Ronald Benitez ◽

Erol Veznedaroglu ◽

Ashwini Sharan ◽

William Mitchell ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Patient Population ◽

Intracranial Aneurysms ◽

Thomas Jefferson ◽

Posterior Communicating Artery ◽

Anterior Communicating Artery ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Ruptured Intracranial Aneurysms ◽

Small Aneurysms

ABSTRACT OBJECTIVE To review our experience and examine the size at which aneurysms ruptured in our patient population. METHODS Patient charts and angiograms for all patients admitted with a diagnosis of subarachnoid hemorrhage to the Thomas Jefferson/Wills Eye Hospital between April 1996 and March 2000 were reviewed. RESULTS Of the 362 cases reviewed, definite measurements of the ruptured aneurysm were obtained in 245. The data clearly showed that most ruptured aneurysms presenting to our institution were less than 10 mm in diameter. We found that, regardless of location on the circle of Willis, 85.6% of all aneurysms presenting with rupture were less than 10 mm. Review by location shows that aneurysms of the anterior communicating artery most often presented with rupture at sizes less than 10 mm (94.4%). A large number of ruptured posterior communicating artery aneurysms also presented at sizes less than 10 mm (87.5%). This trend continued for all aneurysm sites in our review. The incidence of subarachnoid hemorrhage in Western countries is estimated at 10 per 100,000 people per year. Recent reports have indicated that aneurysms less than 10 mm in size are unlikely to rupture. CONCLUSION We argue that the risk of small aneurysms rupturing is not insignificant, especially those of the anterior communicating artery. Our findings indicate that surgery on unruptured aneurysms should not be predicated on aneurysm size alone.

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Five to Ten Years Follow-up after Coiling of 241 Patients with Acutely Ruptured Aneurysms

Interventional Neuroradiology ◽

10.1177/159101991201800101 ◽

2012 ◽

Vol 18 (1) ◽

pp. 5-13 ◽

Cited By ~ 5

Author(s):

A. Consoli ◽

L. Renieri ◽

R. Mura ◽

S. Nappini ◽

F. Ricciardi ◽

...

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Critical Issue ◽

Morphological Data ◽

Long Term Stability ◽

Ruptured Aneurysms ◽

First Choice ◽

Second Procedure ◽

Ruptured Intracranial Aneurysms

Endovascular treatment has assumed a role of first choice in the management of ruptured intracranial aneurysms. We describe the clinical and morphological data after the treatment of 258 ruptured intracranial aneurysms in 241 patients, in order to evaluate the safety and the efficacy of the endovascular treatment. Two hundred and forty-one patients with saccular ruptured aneurysms were treated at our institution between 2000 and 2005. After the endovascular treatment a clinical and angiographic follow-up was conducted. The clinical follow-up was carried out with a medical examination and telephonic interviews and mRS was used for evaluation. Two hundred and forty-nine acutely ruptured aneurysms were successfully treated and immediately after the endovascular procedure 81.9% of the aneurysms resulted completely occluded, 12.1% had a residual neck and 6% revealed a residual sac. The evolution of each grade was evaluated at six months and two years. During the follow-up we observed five early and one late re-bleedings. Twenty-four patients underwent a second procedure. After the discharge and up to ten years 73.1% of patients had a good clinical outcome (mRS0–1), 8.9% died and the remainder showed moderate-severe disability (mRS2–3). The long-term stability of the anatomical result is a critical issue of this approach because eventual re-bleedings may occur even after several months or years. A careful clinical and radiological follow-up for up to two years after the embolization may prevent recurrences but may not be sufficient.

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Techniques and outcomes of microsurgical management of ruptured and unruptured fusiform cerebral aneurysms

Journal of Neurosurgery ◽

10.3171/2016.9.jns161165 ◽

2017 ◽

Vol 127 (6) ◽

pp. 1353-1360 ◽

Cited By ~ 7

Author(s):

Sam Safavi-Abbasi ◽

M. Yashar S. Kalani ◽

Ben Frock ◽

Hai Sun ◽

Kaan Yagmurlu ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Patient Outcomes ◽

Intracranial Aneurysms ◽

Cerebral Aneurysms ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Vascular Bypass ◽

The Mean ◽

Annual Risk

OBJECTIVEFusiform cerebral aneurysms represent a small portion of intracranial aneurysms; differ in natural history, anatomy, and pathology; and can be difficult to treat compared with saccular aneurysms. The purpose of this study was to examine the techniques of treatment of ruptured and unruptured fusiform intracranial aneurysms and patient outcomes.METHODSIn 45 patients with fusiform aneurysms, the authors retrospectively reviewed the presentation, location, and shape of the aneurysm; the microsurgical technique; the outcome at discharge and last follow-up; and the change in the aneurysm at last angiographic follow-up.RESULTSOverall, 48 fusiform aneurysms were treated in 45 patients (18 male, 27 female) with a mean age of 49 years (median 51 years; range 6 months–76 years). Twelve patients (27%) had ruptured aneurysms and 33 (73%) had unruptured aneurysms. The mean aneurysm size was 8.9 mm (range 6–28 mm). The aneurysms were treated by clip reconstruction (n = 22 [46%]), clip-wrapping (n = 18 [38%]), and vascular bypass (n = 8 [17%]). The mean (SD) hospital stay was 19.0 ± 7.4 days for the 12 patients with subarachnoid hemorrhage and 7.0 ± 5.6 days for the 33 patients with unruptured aneurysms. The mean follow-up was 38.7 ± 29.5 months (median 36 months; range 6–96 months). The mean Glasgow Outcome Scale score for the 12 patients with subarachnoid hemorrhage was 3.9; for the 33 patients with unruptured aneurysms, it was 4.8. No rehemorrhages occurred during follow-up. The overall annual risk of recurrence was 2% and that of rehemorrhage was 0%.CONCLUSIONSFusiform and dolichoectatic aneurysms involving the entire vessel wall must be investigated individually. Although some of these aneurysms may be amenable to primary clipping and clip reconstruction, these complex lesions often require alternative microsurgical and endovascular treatment. These techniques can be performed with acceptable morbidity and mortality rates and with low rates of early rebleeding and recurrence.

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