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Keywords:
Interventional vascular, Neuroradiology brain, Catheter arteriography, MR-Angiography, MR, Catheters, Aneurysms
Authors:
M. Zaitoun; Zagazig/EG
DOI:
10.1594/ecr2016/C-2019
Methods and materials
Patient Population :
From 2010 till 2015,
30 cases of distal basilar artery aneurysms were treated by endovascular embolization with GDCs at the Neuroradiology Department of Zurich university hospital.
Twenty-one patients (70%) were women,
and 9 patients (30%) were men.
Mean age of the patients was 61.3 years (range,
47-83 years).
The age distribution included 10 patients (33.33%) between 47 and 55 years old,
9 patients (30%) between 56 and 65 years old and 11 patients (36.67%) older than 65 years old.
The majority was incidentally founded (56.67%) or bled (30%) and only (13.33%) presented with mass effect.
Half of the patients had more than one aneurysm.
Two patients (6.6%) had history of Adult Polycystic Kidney Disease (APKD).
According to Fisher grade {6} in the 9 patients with subarachnoid hemorrhage,
1 patient (11.11%) was grade I and 8 patients (88.89%) were grade IV.
Hypertension was present in 50% of patients,
50% of patients were smokers and 33.33% of patients were alcohol consumers.
Aneurysms Characteristics :
As shown in Table (1) and figure (1),
the vast majority of the aneurysms (73.33%) were located at the basilar tip whereas nearly half were posteriorly oriented.
Twenty-four aneurysms (80%) were regular saccular and 6 aneurysms (20%) were irregular saccular.
Mean aneurysm size was 8.49 mm,
and Mean neck size was 4.33 mm,
with the majority (53.33%) of aneurysms having >4mm (wide neck).
Mean dome to neck ratio was 3.
Endovascular Procedure :
Procedures were done under general anesthesia.
No systemic heparinization was provided.
All endovascular procedures were done with a dedicated neuroangiographic unit with high-quality biplane fluoroscopy and road-mapping capabilities.
Twelve aneurysms (40%) were treated with simple coiling,
18 aneurysms (60%) were treated by multiple microcatheters technique,
the majority (16) of them with double microcatheters technique.
The rest 2 (6.67%) were treated with triple microcatheters technique (Figure 2).
Follow up :
Radiographic findings and clinical data were obtained from the hospital database.
MRI follow up was done yearly with mean follow up of 33.6 months.
The MRI results were classified as complete occlusion (no contrast filling of the dome,
body,
and neck of the aneurysms),
small neck remnant (residual filling of part of the aneurysm neck),
and aneurysm remnant (the body and/or dome of the aneurysm was filled with contrast material through the GDC mesh).