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Safety and Efficacy of Endovascular Treatment of Basilar Tip Aneurysms by Coiling With and Without Stent Assistance: A Review of 235 Cases

Chalouhi, Nohra MD*; Jabbour, Pascal MD*; Gonzalez, L. Fernando MD*; Dumont, Aaron S. MD*; Rosenwasser, Robert MD*; Starke, Robert M. MD; Gordon, David MD*; Hann, Shannon MD*; Tjoumakaris, Stavropoula MD*

doi: 10.1227/NEU.0b013e318265a416
Research-Human-Clinical Studies
CNS University of Neurosurgery

BACKGROUND: Endovascular therapy is now the preferred treatment option for basilar tip aneurysms (BTAs).

OBJECTIVE: To compare the safety and efficacy of common endovascular techniques in the treatment of BTAs.

METHODS: A retrospective review was conducted of 235 patients with BTAs treated with endovascular means in our institution between 2004 and 2011. Categorization was based on the presence and type of stent assistance (none, single, and Y stenting). The rates of perioperative complications, recanalization, rehemorrhage, and retreatment were analyzed.

RESULTS: A total of 147 patients were treated with coil embolization and 88 patients with stent-assisted coiling (72 single stents, 16 Y stents). Thromboembolic complications occurred in 6.8% of patients in both groups. There was no associated mortality. Angiographic follow-up (mean, 23.5 months) was available in 172 patients (77.1%). Stented patients had significantly lower recanalization (17.2% vs 38.9%; P = .003) and retreatment (7.8% vs 27.8%; P = .002) rates compared with nonstented patients. Four rehemorrhages (2.7%) occurred in the coiled group, whereas none were noted in the stented group (P = .3). In paired comparisons, lower recanalization (8.3% vs 19.2%; P = .21) and retreatment (0% vs 9.6%; P = .19) rates were seen in the Y-stent group compared with the single-stent group. Thromboembolic complications occurred in 6.9% and 6.2% of patients in the single-stent and Y-stent groups, respectively (P = .91). In multivariate analysis, larger aneurysms, nonstented aneurysms, incomplete initial occlusion, and subarachnoid hemorrhage were predictors of aneurysm recanalization.

CONCLUSION: Stent-assisted coiling has significantly lower recurrence, retreatment, and rehemorrhage rates than coiling alone for the treatment of BTAs. Y stenting has the highest efficacy with low complication rates.

ABBREVIATIONS: BSA, basilar tip aneurysm

PCA, posterior cerebral artery

*Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania

Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia

Correspondence: Stavropoula I. Tjoumakaris, MD, Assistant Professor, Department of Neurological Surgery, Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University Hospital, 909 Walnut St, 2nd Floor, Philadelphia, PA 19107. E-mail: stavropoula.tjoumakaris@jefferson.edu

Received January 18, 2012

Accepted June 6, 2012

Copyright © by the Congress of Neurological Surgeons