Endovascular Treatment of Complex Distal Part Basilar Artery Aneurysms Using Different Techniques

Objectives: Aneurysm of basilar artery (BA) bifurcation and the origin of superior cerebellar artery (SCA), united in the concept of the BA apex (BAA) aneurysms, along with the size of the aneurysm, is a predictor of the rupture. These lesions more often are challenging for microsurgery. Intervention techniques are more favorable, but the vascular anatomy of this localization requires a careful selection of the endovascular occlusion method. Methods: Between 2016 and 2018 in the neurovascular department, 69 patients with aneurysms of the distal part of BA (dBAA) were operated. There were 15 (21.7%) men and 54 (78.3%) women. The average age of the population was 51.5 years (range, 25–74 years). There were 48 (69.6%) aneurysms on the basilar tip and 21 (30.4%) on the SCA. Most of the aneurysms (88.4%) were less 15 mm. Thirty-six patients had unruptured aneurysms and 33 (47.8%) suffered hemorrhage in anamnesis. Results: A total of 69 endovascular procedures were performed. Coiling was used in 9 (13.1%) patients, coiling with stent assisting – 37 (53.6%) or coiling with balloon assisting – 9 (13.1%), flow diverters (FDs) – 7 (10.1%), and a combination of techniques in 7 (10.1%). Immediate complete occlusion (Raymond I) was achieved in 48 (69.6%) and near-complete (Raymond II) in 12 (17.4%) aneurysms. Occlusion rate in eight patients after FD was evaluated after 6–12 months. Complications leading to permanent morbidity in 3 (4.3%) patients. Mortality 2 (2.9%) patients. Good clinical result (mRs 0–1) has been obtained in 62 (89.8%). Conclusion: Endovascular treatment of aneurysms of the dBAA today is good alternative to open surgery. We have demonstrated complete or near-complete occlusion in 87% after initial treatment, with morbidity of 4.3%. Endovascular embolization is a safe and effective treatment modality in cases of dBAA.

Publication History

Article published online:
26 April 2021