Technical Note & Surgical TechniqueLong-term review of selected basilar-tip aneurysm endovascular techniques in a single institution

- One of the biggest series of a high-volume center experience on basilar tip aneurysm coiling.
- One of the longest follow-up study with > 90% patient can be followed.
- Comparison of three different coiling techniques.
- Important factors of major recanalization were determined and analyzed.

BackgroundSeveral endovascular techniques and devices are presently available for the non-surgical treatment of basilar-tip aneurysms in dedicated neurovascular departments. However, the revolving drawback to treatment to angiographic approach remains the long-term coil-mass durability and less patent published results regarding treatment outcome and long-term efficacy. We aim to share our experience of selected endovascular techniques for treating basilar-tip aneurysms and its long-term clinical and angiographic outcome.Material and methodsWe retrospectively reviewed 109 patients basilar-tip aneurysm who had endovascular treatment in our department from 2003 to 2014. Three groups were based on treatment method: single microcatheter (SM), multiple microcatheters (MM), and stent-assisted (SA) coiling techniques. All procedural-related complications and outcomes were followed and analyzed. Angiographic follow-up with accompanying skull-series review were evaluated from initial coil-mass occlusion time to the last follow-up outpatient attendance.ResultsIn our study, sac size (p < 0.001), neck size (p < 0.001), and ruptured status (p < 0.001), were the determining factors of endovascular techniques selection in treating basilar-tip aneurysm. Technique selection was validated as clinically and angiographically effective over a mean 43.5 month follow-up in 90% of outpatients' attendances. Logistic regression analyses concluded factors that were directly linked to a “major recanalization” outcome include: (i) ruptured-status (p = 0.05), (ii) aneurysm size > 11 mm (p < 0.001), and (iii) aneurysm neck size > 4 mm (p = 0.006).ConclusionSmall aneurysms particularly those with a small-neck size can be treated with SM or MM approach. Medium-large sized aneurysm can be treated effectively by combined MM and SA techniques.