Predictors of periprocedural complications and angiographic outcomes of endovascular therapy in large and giant intracranial posterior circulation aneurysms.

OBJECTIVE: To explore the predictors of periprocedural complications and angiographic outcomes in large and giant intracranial posterior circulation aneurysms after endovascular treatment.

METHODS: Ninety-nine patients with 103 large (size ≥10 mm, n=94) and giant (size >25 mm, n=9) posterior circulation aneurysms treated with endovascular therapy at a single center were retrospectively analyzed. Treatment procedures included endovascular trapping (n=15), coiling (n=6), stent only (n=10), stent-assisted coiling (n=48), and pipeline embolization device (PED, n=24). The outcome endpoints were the number of periprocedural complications and number of complete occlusions without any complication.

RESULTS: Multivariate analysis revealed that intradural vertebral aneurysms (P=0.041) and aneurysms ≤25 mm (P=0.042) were associated with a low periprocedural complication rate after endovascular therapy. Aneurysms not involving side branches (P=0.024) and intradural vertebral aneurysms (P=0.032) were predictors of complete aneurysm obliteration. There were no statistical differences in aneurysmal complete obliteration (P=0.119) and periprocedural complications (P=0.248) between PED and traditional stent and coiling. Additionally, aneurysms not involving side branches (P=0.030), intradural vertebral artery aneurysms (P=0.003), and aneurysms treated by PED (P=0.020) were more likely to achieve complete occlusion over time.

CONCLUSIONS: Aneurysm location, aneurysm size, and side branch involvement were predictors of periprocedural complications and angiographic outcomes of endovascular therapy in large and giant intracranial posterior circulation aneurysms. PED has no advantages over traditional stent and coiling in aneurysmal occlusion and periprocedural complications. Large case-control and long-term follow-up studies are needed to further explore the predictors of complications and angiographic outcomes and optimal treatment options for these aneurysms.