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  • Endovascular Treatment of Complex Aneurysms in a Middle Income Country

    Final Number:

    Pablo Harker MD; Paula Baldrich; Alejandra Pulido-Saavedra; Juan Carlos Puentes

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: The treatment of IAs has always garnered great attention and controversy. Newer devices have allowed safe endovascular therapy of complex and previously untreatable lesions. We present a large cohort of patients who presented with complex aneurysms and were treated at a single institution.

    Methods: Patients with complex, unruptured aneurysms treated at a single institution in Bogotá, Colombia between June/2007 and June/2016 were enrolled. Complex aneurysms were defined as a neck-to-dome ratio above 1.0, multilobulated or distal location (P2/P3, A3, M3 segments or beyond). Complete patient demographical data, aneurysm location and morphology and treatment modality were recorded. Clinical and angiographic follow-up was obtained at least 18 months after treatment. Intraoperative and 30-day postoperative morbidity/mortality as well as recurrence rates were obtained. Multi-variate analyses were performed to determine which variables had impact on patient outcome and lesion recurrence.

    Results: 162 patients with 232 aneurysms were enrolled and followed for an average of 32 months (Range 18.5 – 62). All aneurysms were treated with either stand-alone coiling (22%), balloon-assisted coiling (15%), stent-assisted coiling (51%) or flow-diversion devices (12%). Intraoperative morbidity was 3.5%, 30-day morbidity was 2.9%. There were no procedure-related deaths at 30 days. mRROC class I was obtained on 182 aneurysms (78.4%) on immediate post-operative angiogram. On 18-month follow-up, 82% of RROC Class I aneurysms were angiographically excluded. Ten lesions (4.3%) required additional treatment. No cases of SAH were recorded. Smoking, BMI above 30 and mRROC had statistically significant impact on lesion recurrence.

    Conclusions: Although complete lesion occlusion was relatively low (78%) the complexity of the lesions might explain this finding. However, long-term results are similar to those reported in the literature. The fact that high BMI and Smoking had a statistically significant impact on outcome warrants the question of whether preoperative weight control and smoking cessation should be indicated in unruptured aneurysm treatment.

    Patient Care: It shows that BMI and smoking have a statistically significant impact on aneurysm recanalization rates. Maybe if preoperative weight control and smoking cessation was warranted, treatment success rates would be higher.

    Learning Objectives: By the conclussion of this session participants should be able to 1. Acknowledge the treatment success rates of different endovascular techniques 2. Identify the variables associated with aneurysm recurrence 3. Discuss whether smoking cessation and/or weight control should be indicated before treatment


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