A Study On The Related Factors Affecting The Endovascular Treatment Results Of Intracranial Bifurcation Aneurysms

Purpose: Endovascular treatment of intracranial bifurcation aneurysms has always been a challenging issue for neurointerventionlists.The purpose of this study was to analyze the related factors affecting the endovascular treatment results of intracranial bifurcation aneurysms,so as to provide theoretical evidence and guidance for further improving the therapeutic efficacy of this type of aneurysms.Methods: The clinical date of patients with intracranial bifurcation aneurysm(s)who received endovascular treatment in our center between Jan,2012 and Jun,2019 were analyzed retrospectively,including age,gender,history of hypertension and diabetes,aneurysm location,size,feature of aneurysmal neck,the origin type of aneurysmal neck,rupture status,endovascular therapeutic techniques,immediate and follow-up angiographic results and so on,all date were statistically processed by either single-factor chi square and multi-factor logistic analysis and explore the related factors may influence the embolization results.Results: A total of 202 patients(205 intracranial bifurcation aneurysms)were included in this study.Among all the bifurcation aneurysms,165(80.49%)were ruptured and 40(19.51%)were un-ruptured;There were 152(74.15%)aneurysms within the circle of Willis(74.15%)and 53(25,85%)aneurysms beyond the circle of Willis.The mean aneurysm size was 4.93±2.09 mm.The neck width was 3.11 ± 1.42 mm in average,which was118(57.56%)in line with the standard for wide-neck aneurysms;The origin type of aneurysmal neck: type A 62,type B 108,type C 35;All the aneurysms were received successful endovascular treatment,with 125(60.98%)received standard coiling,35(17.07%)stent-assisted coiling,37(18.05%)balloon-assisted coiling,and 8(3.90%)double microcatheter technique.The rates of immediate adequate occlusion were 61.46%(126/205),and the follow up adequate occlusion rates were 71.17%(116/163).The rates of recurrence and retreatment were 28.83%(47/163)and 11.66%(19/163),respectively.The feature and the origin type of aneurysmal neck are the main factors affecting the immediate angiographic results of intracranial bifurcation aneurysms,while narrow-neck,B type origin were more likely to achieve adequate embolization.Aneurysm rupture status,immediate embolization degree and stent using were the main factors affecting the evolution of bifurcation aneurysm after endovascular treatment,while ruptured,immediate inadequate embolization and no stent using were more likely to recurrence.For complex ruptured bifurcation aneurysms,staged treatment could be selected.Conclusions: The endovascular treatment of intracranial bifurcation aneurysms in our center is safe and effective,but the recurrence rate and retreatment rate are still high.The bifurcation aneurysms with narrow-neck and type B origin were more likely to achieve immediate adequate embolization,the ruptured and immediate inadequate embolization were more likely to recurrence,while stent-assisted treatment could improve the rate of adequate embolization at the last follow-up.