Ендоваскуларен третман на интракранијалните аневризми

Abstract

Introduction: Aneurysm by definition is abnormal focal dilatation of the artery. Aneurysms appears as a result of weakness of the wall or defect in some of the brain artery wall layers. Intracranial aneurysms are heterogeneous in relation to location, shape, size and status in the time of presentation (ruptured vs. unruptured) and by the other factors. Heterogeneous morphometric and clinical characteristic of the aneurysms requires individual approach in the aneurysm treatment. Different modalities of endovascular treatment are available today, customized by the intracranial aneurysms characteristics. Aim of the study: To evaluate characteristic of intracranial aneurysms in order of: location, number, dimensions and shape of the aneurysms. To evaluate efficiency and complication of the endovascular treatment of intracranial aneurysms. Material and methods: This study evaluates representative sample of 113 patients with intracranial aneurysms, from the both gender on the age over 18 years old. In all patients, diagnostic findings are presence of intracranial aneurysms. Different type of endovascular treatments are used for excluding the intracranial aneurysms from the circulation. Endovascular treatment findings are then analyzed and results received are analyzed with an appropriate statistical methods. Results: In this study 38% of the patients were male and 62% were female. Mean age of the patients was 53±10 years. In 79% of the patients, aneurysm was located on the anterior circulation, while in 21% of the patients, aneurysm was located on the posterior circulation. According to the size, 43% of the aneurysms were medium sized, 35% of treated aneurysms were small, 13% were large and 9% of treated aneurysms were giant. In 71.7% of the patients, one aneurysm was detected, while in 28.3% of the patients, multiple aneurysm were detected. In 62% of patients sent for endovascular treatment were with ruptured aneurysm while 38% of treated patients were with unruptured aneurysms, symptomatic or incidental finding of aneurysm at risk of bleeding. In this study, 69% were treated with coiling, 3.5% were treated with stenting, 16.8% were treated with stent assisted coiling and 1.8 % were treated with balloon assisted coiling. Extra saccular flow modification, flow diverter was used in treatment of 4.4% of treated aneurysms, while in some of the giant aneurisms flow diverter plus coils were used in treatment of 1.8%. The occlusion of the parent vessel as a method was used in treatment of 2.7%. Regarding the degree of occlusion, based from different classifications, the one used in this study, complete occlusion with sub-groups is accomplished in 58.4%, immediately after the treatment. Recanalization was noticed in 12.4% of patients that were follow up, while 6.2% were re-treated. In the course of the treatment, in 30% of the patients complications were detected, with morbidity of 5.3% and mortality of 1.8%. Conclusion: Endovascular treatment of intracranial aneurysms is becoming first line treatment because it can be performed in most complex aneurysms on almost any location due to new technology devices and option for individual treatment method. Low morbidity and mortality rate and fact that most of the complication can be solved make this treatment of choice.