Purpose

The best treatment for distal basilar artery aneurysms is controversial. We aimed to review our single-centre experience with coil embolisation of aneurysms at this location and compare it with the surgical and endovascular literature.

Methods

Forty-two aneurysms in a distal basilar location in 42 consecutive patients (15 ruptured and 27 unruptured) were treated endovascularly from 2010 to 2015. Unassisted single and multiple microcatheter coil embolisation alone was used in all cases. We studied our immediate and long-term anatomical results, operative complications, and outcome.

Results

The immediate angiographic results showed complete occlusion in 34 (81%), a neck remnant in seven (16.6%) and a residual aneurysm in one patient (2.4%). There were two thromboembolic events (4.7%) without clinical sequelae; therefore, the operative morbidity and mortality were zero.

Three patients with ruptured aneurysms (7.1%) died due to complicated vasospasm. Thirty-nine patients (93%) had clinical and MR imaging follow-up (mean 32.3 months ± 18.6, range from 12 to 66 months). There was recanalization in 30.8% with a retreatment rate of 15.3% and no new bleedings. The aneurysm size was the most important predictor of early anatomical outcome and recurrence.

Conclusion

Unassisted and multiple microcatheter coiling is a safe treatment for distal basilar aneurysms. Early anatomical results and recurrence depend on the aneurysm size. Morbidity and mortality are lower and recurrence rates are higher in comparison with clipping or other adjunctive endovascular techniques.

中文翻译：

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远端基底动脉瘤的无辅助和多微导管卷绕术：结果和文献回顾

目的

远端基底动脉瘤的最佳治疗方法存在争议。我们的目的是回顾我们在该位置对动脉瘤进行弹簧圈栓塞的单中心经验，并将其与外科和血管内文献进行比较。

方法

从 2010 年到 2015 年，连续 42 名患者（15 名破裂和 27 名未破裂）的远端基底动脉位置的 42 个动脉瘤接受了血管内治疗。所有病例仅使用无辅助的单根和多根微导管弹簧圈栓塞术。我们研究了我们的即时和长期解剖结果、手术并发症和结果。

结果

即时血管造影结果显示 34 例 (81%) 完全闭塞，7 例 (16.6%) 存在颈部残余，1 例 (2.4%) 存在残余动脉瘤。有两次血栓栓塞事件 (4.7%) 没有临床后遗症；因此，手术发病率和死亡率为零。

3 例动脉瘤破裂患者 (7.1%) 死于复杂的血管痉挛。39 名患者 (93%) 进行了临床和 MR 成像随访（平均 32.3 个月±18.6 个月，范围从 12 个月到 66 个月）。再通率为 30.8%，再治疗率为 15.3%，无新出血。动脉瘤大小是早期解剖结果和复发的最重要预测指标。

结论

无辅助和多微导管盘绕术是远端基底动脉瘤的安全治疗方法。早期解剖结果和复发取决于动脉瘤的大小。与夹闭或其他辅助血管内技术相比，发病率和死亡率较低，复发率较高。