Endovascular Treatment of Patients with Ruptured Intracranial Aneurysms: A Series of 468 Patients Treated Over a...

Non-traumatic subarachnoid hemorrhage (SAH) is an emergency usually caused by the rupture of a saccular intracranial aneurysm. Endovascular treatment (EVT) is now considered as the first therapeutic option. The aim of our study is to evaluate, over a 14-year period in a single center, the result of EVT of ruptured intracranial aneurysms.

From the retrospective analysis of our prospectively maintained database, we collected data of 457 patients successfully treated by endovascular approach for a SAH. Descriptive statistics and percentages were used to report clinical and anatomical outcomes, procedure-related complications, post procedural events, morbidity and mortality.

EVT was unsuccessful in eleven patients but effective in 457 patients with two patients who experienced a rebleeding (0.4%). In 6.3% of cases, a second EVT was necessary. The final aneurysm occlusion was complete (65.7%), with a neck remnant (28.2%) or incomplete (6.1%). Procedure-related complications occurred in 5.9% of patients and were associated with five clinical worsening and one death. Overall EVT-related morbidity and mortality were thus of 1.3% and 0.4% respectively. At discharge, 71% of patients had a good recovery (mRS 0-2), 11.2% had a poor outcome (mRS 3-5), and 17.8% died.

This study seems to prove that high-volume centers with experienced interventional neuroradiologists carry low rates of technical failure and complication from EVT of ruptured intracranial aneurysm.