Experiences and complications in endovascular treatment of paraclinoid aneurysms

摘要

Endovascular treatment is a promising therapeutic alternative for paraclinoid aneurysms. The purpose of this study was to assess the feasibility and results of endovascular treatment for these lesions. We retrospectively reviewed the clinical data, results and complications of endovascular treatment of a series of 47 consecutive patients with paraclinoid aneurysms. Nineteen of these patients presented with acute subarachnoid hemorrhage, and 28 patients were treated for unruptured aneurysms. Endovascular treatment was performed for 50 aneurysms in 47 patients including stent-assisted coiling (19), balloon-assisted coiling (five), coiling without adjunctive techniques (25) and stent alone (one). Technical failures occurred in two patients (one stent deployment failure due to unsuccessful distal access across the aneurysm neck and one coiling failure due to unsuccessful microcatheter navigation through the stent). Periprocedural complications were observed in six patients (12.8%), with permanent morbidity in one patient resulting from a thromboembolic event. Immediate complete occlusion was achieved in 36 aneurysms (72%). During follow up, enlargement of a partially occluded giant aneurysm was observed in one patient, which was treated with parent artery occlusion. No delayed hemorrhagic complications were seen in the remaining patients. Endovascular treatment is technically feasible and safe in most patients with paraclinoid aneurysm, with a low rate of procedural complications.