Endovascular Treatment of Spontaneous Intracranial Fusiform and Dissecting Aneurysms: Outcomes Related to Imaging Classification of 309 Cases

World Neurosurg. 2017 Feb:98:444-455. doi: 10.1016/j.wneu.2016.11.074. Epub 2016 Nov 24.

Abstract

Objective: To propose a modified classification system for spontaneous intracranial dissecting aneurysms (IDAs) that can guide treatment decisions.

Methods: Between January 2010 and December 2015, 3183 consecutive patients were referred to our department for endovascular treatment of a cerebral aneurysm. Among this group, 309 patients harboring a total of 323 spontaneous IDAs were identified. Based on a modified imaging classification system, spontaneous IDAs were classified into 4 subtypes: classic dissecting aneurysm, segmental ectasia, dolichoectatic dissecting aneurysm, and large mural bleeding ectasia. A logistic regression analysis was conducted to identify predictors of clinical outcomes.

Results: Of the 323 IDAs, 216 (66.87%) were treated with stent-assisted coiling, 47 (14.55%) with internal trapping, and 60 (18.58%) with sole stenting. Of the 309 patients, 8 (2.59%) suffered intraoperative complications, 40 (12.94%) experienced postoperative complications, 9 died (2.79%), and 1 (0.32%) had severe disability. The mean duration of clinical follow-up of the 309 patients was 10.40 months (range, 3-72 months). Imaging follow-up was available for 262 patients (274 IDAs), with a mean duration of 7.10 months (range, 3-60 months), and 24 aneurysm recurrences (9.16%) were noted. Aneurysm type was the sole independent predictor of different outcomes on logistic regression analysis (P = 0.004).

Conclusions: There was a strong relationship between the subtypes of spontaneous IDAs and clinical course. Our classification system is confirmed to be helpful in assessing patients' prognosis and guiding their treatment.

Keywords: Classification; Dissecting; Endovascular procedures; Intracranial aneurysm; Prognosis.

MeSH terms

  • Adult
  • Aneurysm / classification
  • Aneurysm / diagnostic imaging
  • Aneurysm / surgery
  • Aortic Dissection / classification*
  • Aortic Dissection / diagnostic imaging*
  • Aortic Dissection / surgery
  • Endovascular Procedures / methods*
  • Endovascular Procedures / trends
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Aneurysm / classification*
  • Intracranial Aneurysm / diagnostic imaging*
  • Intracranial Aneurysm / surgery
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome