Intraoperative complications of endovascular management for intracranial aneurysms / 中华急诊医学杂志

ABSTRACT

Objective To summarize the clinical experience of endovascular intervention for intra-cranial aneurysms, especially in the respect of the technique and management of intra-operative complications. Method The clinical data of 60 patients with intra-cranial aneurysms treated with endovascular intervention in the past 3 years were analyzed. The relevant literature especially with regard to the practical technique described was reviewed so as to potentiall minimize and properly manage the intra-operative complications. Results A total of 69 sacciform aneurysms and one dissecting aneurysm located at left vertebral artery (VA) were detected by using digital subtraction angiography (DSA) in 60 patients. There were 65 saccular aneurysms obliterated with constructive approach, and five of them treated with stent-assisted technique and four of them treated with ballon-assisted technique. The VA dissecting aneurysm was obliterated with coils by deconstructive approach with complete occlusion of its parent vessel. There were a total of 53 complete occlusions of aneurysms accounted for 76.81% of 69 sacciform aneurysms in 51 patients ( 85 % ) and eight subtotal occlusion of aneurysms (95 % ～ 99 % occlusion) accounted for 13.56% of total sacciform aneurysms in five patients (8.47%) and four incomplete occlusion of aneurysms ( ＜ 95% occlusion) accounted for 6.78% of total sacciform aneurysms in three patients (5.08%), and one was failure in operation. The rupture of aneurysms occurred during operation in4 patients (6.78%). Two senile patients suffered from intra-opeartive symptomatic thromboembolisn. One patient had stent shifting and spring coil dislocated and moved into the M3 segment of the ipsilateral MCA. Vasospasm occurred in 15 patients during operation, and most of them received endovascular intervention 3 days after the initial ictus. The rate of good recovery was 93.3% at discharge from hospital (the modified Rankin Scales, mRS＜ 2). There were 55 patients followed up for up 24 months after discharge, and excellent recovery rate was found in 51 patients ( mRS ＜ 2), and 3 died.During the follow-up period, no aneurismal recanalization or rupture was noticed in all patients. Conclusions The endovascular intervention is a safe and effective approach to the intra = cranial aneurysms. Advances in the skill of technique and proper management will decrease the complications during operation and improve the prognosis of patients.