Endovascular treatment of distal cerebral aneurysms

Abstract

Background. Due to rare occurrence of distal cerebral aneurysms, there are very few publications devoted to endovascular treatment. Due to current progress in the endovascular surgery, the number of successfully cured patients with distal aneurysms has been increasing recently. Aim. To determine technical capabilities and evaluate results of endovascular treatment of patients with distal intracranial aneurysms. Materials and methods. The work is based on analysis of data of endovascular treatment among 45 patients with distal cerebral aneurysms in two neurosurgical departments of federal medical centers. Of the 45 analyzed cases 30 were without aneurysm rupture and 15 were with rupture. Results. Endovascular treatment of the distal aneurysms made it possible to achieve good treatment results (4–5 points on the Glasgow Outcome Scale (GOS)) in 97.8 % of cases: 5 points on GOS – in 68.9 %, 4 points on GOS – in 28.4 %. One (2.2 %) fatal outcome was obtained. The most frequent methods of embolization were embolization of aneurysm by coils with stent assistance (37.8 %) and installation of a flow-diverter stent (28.9 %). Embolization with only coils (20 %) or occlusion of parent artery (13.3 %) were used less frequently. In 3 out of 6 patients, the occlusion of parent artery was not planned. Conclusion. Development of endovascular surgery and technical capabilities of performing operations in the distal cerebral arteries has made it possible to form a multidisciplinary approach to choosing the optimal method of shutting off the distal aneurysm from the bloodstream, taking into account the modern possibilities of open surgery. This is especially important for patients in serious condition due to ruptured aneurysm.