J Korean Neurosurg Soc.  2021 May;64(3):427-436. 10.3340/jkns.2020.0195.

The Fate of Partially Thrombosed Intracranial Aneurysms Treated with Endovascular Intervention

• Lee J
• Cho WS
• Yoo RE
• Yoo DH
• Cho YD
• Kang HS
• Kim JE

• KMID: 2515499
• DOI: http://doi.org/10.3340/jkns.2020.0195

Abstract

Objective
: The fate of partially thrombosed intracranial aneurysms (PTIAs) is not well known after endovascular treatment. The authors aimed to analyze the treatment outcomes of PTIAs.
Methods
: We retrospectively reviewed the medical records of 27 PTIAs treated with endovascular intervention between January 1999 and March 2018. Twenty-one aneurysms were treated with intraluminal embolization (ILE), and six were treated with parent artery occlusion (PAO) with or without bypass surgery. Radiological results, clinical outcomes and risk factors for major recurrence were assessed.
Results
: The initial clinical status was similar in both groups; however, the last status was better in the ILE group than in the PAO group (p=0.049). Neurological deterioration resulted from mass effect in one case and rupture in one after ILE, and mass effect in two and perforator infarction in one after PAO. Twenty cases (94.2%) in the ILE group initially achieved complete occlusion or residual neck status. However, 13 cases (61.9%) showed major recurrence, the major causes of which included coil migration or compaction. Seven cases (33.3%) ultimately achieved residual sac status after repeat treatment. In the PAO group, all initially showed complete occlusion or a residual neck, and just one case ultimately had a residual sac. Two cases showed major recurrence, the cause of which was incomplete PAO. Aneurysm wall calcification was the only significantly protective factor against major recurrence (odds ratio, 36.12; 95% confidence interval, 1.85 to 705.18; p=0.018).
Conclusion
: Complete PAO of PTIAs is the best option if treatment-related complications can be minimized. Simple fluoroscopy is a useful imaging modality because of the recurrence pattern.

Keyword

Intracranial aneurysm; Endovascular procedures; Treatment outcome; Risk factors

Figure

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  Fig. 1. An approximately 20-mm-sized thrombosed aneurysm arising from the basilar artery on cerebral angiography (A) and time-of-flight magnetic resonance angiography (B; arrow : basilar artery, dotted arrow : thrombus). After the initial stent-assisted intraluminal coil embolization, the coil mass and stent (dotted lines) were identified on fluoroscopy (C) and magnetic resonance imaging (D; arrow : basilar artery, dotted arrow : coil mass). During the follow-up, however, aneurysm recurrence was identified at 24 months, and aneurysm growth (approximately 28 mm) and the migration of the coil mass were definitely demonstrated at 30 months on fluoroscopy (E; dotted lines: stent, black arrows: coil migration from the stent) and magnetic resonance imaging (F; arrow : basilar artery, thick arrow : recurred sac, dotted line : migrating coil mass).

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  Fig. 2. An approximately 18-mm-sized thrombosed aneurysm at the left vertebral artery presenting with subarachnoid hemorrhage on cerebral angiography (A) and computed tomography (B). Parent artery occlusion (the trapping of the proximal vertebral artery and intraluminal embolization) was performed (C). Coil mass (white arrow) and intra-aneurysmal thrombus (dotted black arrow) were identified on the 1-month follow-up time-of-flight magnetic resonance angiography (D). On the 14-month follow-up imaging, the thrombus was completely resolved, and a coil mass (white arrow) was observed (E).

Reference

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