Endovascular treatment of basilar tip aneurysms in the era of endosaccular flow disruption: a comparative study
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INTERVENTIONAL NEURORADIOLOGY
Endovascular treatment of basilar tip aneurysms in the era of endosaccular flow disruption: a comparative study Yigit Ozpeynirci 1 Franziska Dorn 1
&
Bettina Hutschenreuter 1 & Robert Forbrig 1 & Hartmut Brückmann 1 & Thomas Liebig 1 &
Received: 18 May 2020 / Accepted: 9 September 2020 # The Author(s) 2020
Abstract Purpose This study aims to compare endosaccular flow disruptor (EFD) for treatment of basilar tip aneurysm (BTA) with coiling in terms of safety and efficacy. Methods We retrospectively reviewed patients treated with an EFD for BTAs at our institution between 2013 and 2019 to standard coiling from the same period (control group). Patient demographics, aneurysm characteristics, procedural data, complications and clinical and angiographic outcome were compared between groups. Results Twenty-three (56%) patients were treated with an EFD and eighteen (44%) patients were treated with coiling. Average aneurysm size was 8 mm in the EFD group and 6.9 mm in the coiling group, respectively (P = 0.2). Average fluoroscopy time, treatment DAP and air kerma were 33 min, 76 Gycm2 and 1.7 Gy in the EFD group and 81 min, 152 Gycm2 and 3.8 Gy in the coiling group, respectively (P < 0.001). In the EFD group, clinically relevant thromboembolic complications occurred in one patient (4%) vs. in 5 patients (28%) in the coiling group (P = 0.07). In each group, 4 patients had an unfavourable outcome at discharge (P = 0.7). Adequate occlusion rates were 96% in the EFD group and 100% and coiling group. Six (26%) patients were prescribed long-term antiplatelet therapy in the EFD group vs. eleven (61%) patients in the coiling group (P = 0.02). Conclusion Both treatment concepts provided similar technical success and safety. However, procedure time, radiation exposure and a need for long-term antiaggregation were lower with EFD. Keywords Aneurysm . Endovascular . Endosaccular . Web . Coils
Introduction Endovascular occlusion is the treatment of choice for basilar tip aneurysm (BTA). However, the anatomy of the basilar apex and the often broad-based configuration of BTAs may make treatment challenging. A variety of different techniques has been developed to enable safe and successful endovascular treatment of bifurcation aneurysms including balloon and stent assistance in various configurations and recently developed neck-bridging
* Yigit Ozpeynirci [email protected] 1
Department of Neuroradiology, Ludwig Maximilian University, Munich, Germany
devices [1, 2]. However, all these techniques require several steps, making the procedure complex and prone to device- and procedure-related complications. The Woven EndoBridge (WEB; Microvention/Terumo, Aliso Viejo, CA, USA) is deployed completely endosaccular in order to reduce the inflow into the aneurysm at the level of the neck, thus leading to thrombus formation and potentially shrinkage of the aneurysm sac. The technical success and safety of WEB was supported by several studies resulting in widespread use for both ruptured and un
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