Endovascular Treatment of Multiple Intracranial Aneurysms: A Multicenter Study from Türkiye on Morphology-Based Strategies and Clinical Outcomes.

Abstract

Aim: To evaluate the role of recent endovascular techniques as less invasive alternatives in the management of multiple intracranial aneurysms, particularly in the context of heterogeneous aneurysm morphology and anatomical complexity.

Material and methods: This retrospective analysis included 65 patients with a total of 151 MIAs that were treated using endovascular approaches. Morphological parameters, anatomical location, and clinical features were evaluated. Treatment strategies included primary coiling, stent-assisted coiling, Y/X-stent coiling, flow diversion (with or without coiling), use of Woven EndoBridge devices, and parent artery occlusion. Patient outcomes were assessed radiologically (Raymond-Roy Occlusion Classification) and clinically (Modified Rankin Scale, Glasgow Outcome Scale).

Results: Morphometric parameters significantly differed by aneurysm location. Flow diversion was preferred for wide-necked ınternal carotid artery aneurysms, while coiling was more commonly used for aneurysms at bifurcation sites. Complete occlusion (Class I) was achieved in 70.2% of the cases, while residual neck/sac (Classes II-IIIa) were observed in 29.8% of the cases. Incomplete occlusion was associated with higher aspect ratios and was more frequent in aneurysms in the anterior and posterior communicating arteries and at the middle cerebral artery bifurcation. The clinical outcomes were favorable, with median Modified Rankin Scale and Glasgow Outcome Scale scores of 0.5 and 5, respectively. The mortality rate was 12%, with a median follow-up of 8.5 months.

Conclusion: Endovascular therapy provides a safe and effective approach to treat MIAs. Aneurysm morphology, especially location and aspect ratio, significantly influences angiographic outcomes, supporting the need for individualized treatment plans.