CHALLENGES IN ENDOVASCULAR TREATMENT OF WIDE NECK ANEURYSMS

Abstract

Background: An aneurysm is an abnormal focal dilatation of an artery. Most of the unruptured aneurysms are asymptomatic and discovered incidentally or some of them symptomatic with mass effect or nerve palsy, but rupture of aneurysm results in a potentially life-threatening subarachnoid haemorrhage. Aneurysms with wide necks are defined by neck diameters greater than 4 mm or dome-to neck ratios less than 2 and are the most difficult to treat with the endovascular method. Aim: This study aimed to analyse the decision and type of endovascular treatment of intracranial aneurysms with a wide neck. Methods: The study population included 56 patients with 67 aneurysms referred to the University Clinic of Radiology in Skopje, the Republic of Macedonia for endovascular treatment during the period from 2017 to 2019. This study included 29 females and 18 males, ranging in age from 25 to 74 years. Results: From total 56 treated aneurysms 19 were ruptured and 37 unruptured. Six patients were with multiple aneurysms. In these study complex aneurysms were treated with combined technique, 9 with balloon-assisted coiling, 28 with stent-assisted coiling, 6 stents, 3 with flow diverter assisted coiling, 13 FD and 3 with partial coil filling, 5 with coiling and neck remodeling without assistance device. Conclusion: Aneurysms with wide neck remain a challenge for endovascular treatment. But the development of new techniques and materials in the treatment of aneurysms makes endovascular treatment of intracranial aneurysms safe and feasible.