Endovascular treatment of fusiform aneurysms of the vertebral arteries
Objective ‒ to assess the outcomes and effectiveness of endovascular treatment in patients diagnosed with fusiform aneurysms of the vertebral arteries. Materials and methods. The study assessed the treatment outcomes of 211 patients diagnosed with fusiform aneurysms (FA) of cerebral vessels, all of...
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| Format: | Article |
| Language: | English |
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NAMS of Ukraine, State Organization "Scientific-Practical Center of Endovascular Neuroradiology, Non-Governmental Organization “All Ukrainian Association of Endovascular Neuroradiology, Shupyk National Healthcare University of Ukraine
2025-02-01
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| Series: | Українська Інтервенційна Нейрорадіологія та Хірургія |
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| Online Access: | https://enj.org.ua/index.php/journal/article/view/286 |
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| Summary: | Objective ‒ to assess the outcomes and effectiveness of endovascular treatment in patients diagnosed with fusiform aneurysms of the vertebral arteries.
Materials and methods. The study assessed the treatment outcomes of 211 patients diagnosed with fusiform aneurysms (FA) of cerebral vessels, all of whom received treatment at the SO «Scientific Practical Center of Endovascular Neuroradiology NAMS of Ukraine» between 2009 and 2024. Fusiform aneurysms of the vertebral arteries were detected in 39 (18.4 %) cases. Among patients were 18 men (46.1 %) and 21 women (53.9 %), age ‒ from 9 to 72 years, mean age ‒ 45.3 years. Aneurysms were initially detected using neuroimaging techniques, including multislice computed tomography, magnetic resonance imaging, and magnetic resonance imaging with an angiography programme. All patients underwent digital subtraction angiography. Surgical intervention was performed on 33 (84.6 %) out of 39 patients, while 6 (15.4 %) patients were not operated on due to various reasons (severity of condition, refusal of surgery). All surgical procedures were endovascular. In 29 (87.9 %) patients, reconstructive exclusion of aneurysms from the bloodstream was performed (31 procedures in total). Depending on vascular anatomy, aneurysm structure, size, and disease stage, the following methods were used: implantation of a protective stent (19 cases), implantation of a protective stent with diverticulum occlusion using microcoils (3 cases), implantation of a graft stent (3 cases), implantation of a flow-diverting stent (4 cases), implantation of a flow-diverting stent with microcoil occlusion of the diverticulum (1 case), and combined implantation of a flow-diverting and protective stent (1 case). In 4 (12.1 %) patients, deconstructive exclusion of the FA was performed using detachable microcoils. Clinical outcomes of endovascular treatment were assessed using the Glasgow Outcome Scale.
Results. Among the operated patients, total intraoperative exclusion of FA from the bloodstream was achieved in 11 (33.3 %) cases. In 8 (24.2 %) cases, a reduction in clinical symptoms was observed in the early postoperative period (5–7 days). However, in 11 (33.3 %) cases, an increase in neurological deficits occurred due to intracranial stent implantation, resulting in the emergence or worsening of brainstem symptoms. The surgical mortality rate was 6.1 % (2 cases of deconstructive exclusion), linked to coexisting cardiovascular pathology — one patient suffered an acute large-focal myocardial infarction on postoperative day 4, and another experienced acute cardiovascular failure on day 8. Among 31 (93.9 %) surviving patients, clinical outcomes at hospital discharge (assessed via the Glasgow Outcome Scale) were as follows: good recovery (≥5 points) in 17 (51.5 %) patients, and satisfactory recovery (4 points) in 14 (42.4 %) patients. Follow-up examinations were conducted on 19 (61.3 %) patients within 6 to 9 months. Angiographic findings showed total aneurysm exclusion in 11 (57.9 %) cases, a reduction of FA volume by >70 % in 5 (26.3 %) cases, and a reduction of 50–60 % in 3 (15.8 %) cases. Between 9 and 18 months, follow-up examinations were conducted on 11 (35.5 %) patients, with angiographic results indicating total aneurysm exclusion in 7 (63.6 %) cases, >70 % volume reduction in 3 (27.3 %) cases, and a 50–60 % volume reduction in 1 (9.1 %) case.
Conclusions. Endovascular surgery offers a diverse range of techniques for the effective treatment of patients with FA of the vertebral arteries. These techniques minimise surgical trauma and accelerate rehabilitation, making them an essential tool in modern neurosurgical practice. |
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| ISSN: | 2786-4855 2786-4863 |