Endovascular embolization of ruptured and unruptured posterior circulation aneurysms. A multi-factor analysis
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Published on: August 11, 2015
Tomasz Tykocki1, Paweł Nauman, Bogusław Kostkiewicz
1Institute Psychiatry and Neurology, Department of Neurosurgery, Warsaw, Poland. ttomasz@mp.pl
Insights
Achieving complete aneurysm obliteration is crucial for preventing rebleeding. A narrow aneurysm neck is the strongest predictor of successful endovascular embolization, improving treatment outcomes.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Neurology
Background:
- Complete obliteration of cerebral aneurysms is a primary goal in treatment to minimize rebleeding risk.
- Endovascular techniques are increasingly utilized for treating posterior circulation aneurysms.
Purpose of the Study:
- To identify predictors of successful complete occlusion in posterior circulation aneurysms treated with endovascular embolization.
- To evaluate the influence of patient and aneurysm characteristics on embolization effectiveness.
Main Methods:
- Retrospective analysis of 63 patients with posterior circulation aneurysms undergoing endovascular treatment.
- Stratification of occlusion rates into complete, incomplete, and partial groups.
- Multi-factor analysis using probit and linear regression models to assess influencing factors.
Main Results:
- Complete occlusion was achieved in 57.1% of aneurysms.
- Aneurysms with a neck size of 1-2 mm had a 75% complete occlusion rate, compared to 38.7% for those with a 2-4 mm neck.
- Narrow neck size was the sole independent predictor of complete occlusion in the multi-factor analysis.
Conclusions:
- Aneurysm neck size is the most significant predictor of successful complete occlusion following endovascular embolization.
- Targeting narrow-necked aneurysms may improve treatment success rates in the posterior circulation.
Aim:
Complete aneurysm obliteration reduces the risk of rebleeding and is an important goal of the aneurysm treatment.
Material And Methods:
A retrospective analysis of 63 patients undergoing endovascular treatment of posterior circulation aneurysms. The occlusion rate was stratified to three groups: complete, incomplete and partial. In the analysis compared the influence of the selected characteristics: age, sex, WFNS grade, aneurysm location, size of the aneurysm dome and neck, neck to dome ratio, on the effectiveness of embolization in each group. A multi-factor analysis with probit model and linear regression was applied to assess the impact of all characteristics on the complete occlusion.
Results:
In the series of 63 single aneurysms, 51 were ruptured and 12 unruptured aneurysms. Complete occlusion was achieved in 36 (57.1%), incomplete in 15 (23.8%), partial in 12 (19%) patients. In patients with the neck size of 1-2 mm the complete occlusion was in 75% (24/32) incomplete in 12,5% (4/32), while when the neck size was 2-4 mm these rates were 38.7% (12/31) and 29% (9/31) respectively. The predictor of total occlusion in probit and linear regression model was only one independent variable, the narrow-neck size.
Conclusion:
Multi-factor analysis found that the strongest predictor of the complete occlusion is the aneurysm neck size.
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