Authors: Dejan Daskalov, Petar Janevski, Vjolca Aliji, Elizabeta Srbinovska Kostovska.
Aim: To assess the risk factors in patients with cerebral aneurysms, the location and type of brain aneurysms, and to evaluate complications during and within 6 months after endovascular treatment, as well as to assess the value of interventional endovascular radiology procedures between non-bleeding and bleeding aneurysms.
Materials and Methods: The study analyzed 80 patients sent to the Institute of Radiology for diagnosis and treatment of brain aneurysms. In the diagnostic phase of aneurysm treatment, we used CT angiography, magnetic resonance angiography (MRA) of the brain, classical puncture angiography via Seldinger through a biplane angiograph, and in the therapeutic treatment, i.e., coiling, we used a biplane angiograph, appropriate vascular catheters of various shapes and sizes, microcatheters and wires, specially designed coils and stents, as well as appropriate medicinal preparations, iso-osmolar iodinated contrast medium.
Results: In this study, the gender structure of patients with ruptured and unruptured aneurysms was significantly different. Ruptured aneurysms were significantly more frequently diagnosed in male patients (84.38%) compared to the female population (62.5%). There was no statistically significant difference in the average age between patients with ruptured and unruptured aneurysms (55.8 ± 9.5 vs 56.8 ± 12.3 years). A statistically significant difference was detected in the distribution of small, large, and giant aneurysms between the groups of ruptured and unruptured aneurysms, showing that small aneurysms were insignificantly more frequently bleeding (77.19% vs 56.52%), large aneurysms were insignificantly more frequently non- bleeding (26.09% vs 21.05%), and giant aneurysms were significantly more frequently non- bleeding (17.39% vs 1.75%). Coiling intervention was performed in 78.75% of patients, while the remaining 21.25% underwent a combined method (7 had a stent placed, 10 had a flow diverter). Recanalization was performed in 16.25% of patients. Bleeding complications occurred in 22.5% of patients, while procedural complications were registered in 6.25% of patients.
Repeat treatment due to recanalization or bleeding complications was performed in 8.75% of patients. During the intervention or in the early post-intervention phase up to 6 months, 4 patients died, resulting in a lethality rate of 5%. Aneurysms were non-bleeding (unruptured) in 28.75% and bleeding (ruptured) in 71.25% of patients. Regarding the type of bleeding, 40% of patients had only subarachnoid hemorrhage, 11.25% had intracerebral hemorrhage, 17.5% had intraventricular hemorrhage, and 2.5% had subarachnoid hemorrhage with both intracerebral and intraventricular hemorrhage.
Conclusion: Endovascular treatment of brain aneurysms is a minimally invasive method of choice with optimal benefit for patients during the procedure and in the post-therapeutic period, contributing to full recovery. The method is emerging as the gold standard compared to other therapeutic surgical procedures.
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