Complications and recanalization after endovascular treatment of different types of basilar tip aneurysms: a two-center retrospective study

Abstract

BACKGROUND: Endovascular treatment (EVT) for basilar tip aneurysms (BTAs) remains challenging despite the development of interventional procedures. This study evaluated the effectiveness and recanalization of different types of basilar tip aneurysms that were treated with endovascular procedures. METHODS: We collected clinical and imaging data from patients with BTAs who received endovascular treatment at two hospitals from 2010 to 2022. This study emphasizes a new parameter, the local bifurcation angle (LBA). The patients’ clinical records, aneurysm characteristics, and clinical and angiographic outcomes were also reviewed. BTAs were categorized as hopper, arrow, or wedge types according to the LBA. We evaluated predictive factors for complications and compared the angiographic outcomes of the three types of BTAs. RESULTES: Data from 102 patients with 102 BTAs were analyzed. In total, 64 patients (62.7%) were treated with stent assistance, and hopper BTAs accounted for up to 51.0% (52/102) of the total. Periprocedural complications were observed in 10 of the 102 patients (9.8%). Thromboembolic complications were the major source of morbidity in the EVT of BTAs. During the follow-up period, multivariate analysis showed that increasing aneurysm size (OR = 1.141, p = 0.016), rupture at admission (OR = 0.184, p = 0.184), and stent assistance (OR = 6.050, p = 0.015) were statistically significant predictors of clinical complications. Sixteen out of 67 BTAs (23.9%) were recanalized during imaging follow-up. There was a significant difference in the rate of recanalization in wedge-type and hopper-type BTAs (p = 0.006). CONCLUSIONS: The endovascular treatment of basilar tip aneurysms is considered safe and acceptable. This study showed that complications occurred more frequently in larger, ruptured, and stent-assisted coiling aneurysms. Wedge-configuration BTAs deserve further attention to investigate their high rate of recanalization.