Reconstructive endovascular treatment of patients with ruptured distal intracranial aneurysms in posterior circulation: a retrospective cohort study.

Background: Cases of ruptured distal intracranial aneurysms (DIAs) in the posterior circulation are rare. Currently, the most commonly used approach in clinical practice to treat this condition is reconstructive endovascular treatment. However, research on endovascular treatment of intracranial posterior circulation ruptured DIAs is currently lacking. This study aimed to analyze the safety and efficacy of reconstructive endovascular treatment for DIAs in the posterior circulation.

Methods: A retrospective cohort study was conducted on patients with ruptured distal posterior circulation aneurysms who underwent endovascular reconstructive treatment at The First Affiliated Hospital of Harbin Medical University from September 2014 to August 2023. We collected and analyzed the patients' characteristics, clinical outcomes, and angiographic follow-up results. Complications were determined and recorded based on the patients' hospital records and imaging examination results. Clinical information was collected through neurological assessments and follow-up telephone interviews. Follow-up angiographic evaluations using digital subtraction angiography (DSA) were planned for 6 months after the procedure until 1-year postprocedure.

Results: The procedure was successfully performed on all 49 patients. Among the patients, 16 (32.7%) were males. The mean age of all patients was 59.0±12.7 years. A total of 15 (30.6%) patients used stent-assisted coiling. During hospitalization, 16 (32.7%) patients experienced complications, including 6 with hemorrhagic complications, 7 with ischemic complications, and 4 with shunt-dependent hydrocephalus. One patient had both shunt-dependent hydrocephalus and ischemic complications. Three (6.1%) patients died during hospitalization, all related to aneurysm rebleeding. All patients underwent clinical follow-up, with a median follow-up time of 39 months [interquartile range (IQR), 21.0-70.5 months]. At the last follow-up, 42 (85.7%) patients had a modified Rankin scale score of 0-2. During the follow-up period, one patient died, resulting in an overall mortality rate of 8.2% (4/49). A total of 35 surviving patients underwent angiographic follow-up, with a follow-up rate of 76.1% (35/46) and a median follow-up time of 8.5 months (IQR, 6.0-12.0 months). Among the follow-up patients, 94.3% were classified as Raymond-Roy grade 1-2, and two patients experienced residual aneurysm. Survival analysis showed a 1-year complication-free survival rate of 69.4% and a 1-year overall survival rate of 89.3%.

Conclusions: This study found that the incidence of complications during hospitalization was relatively high. However, the clinical follow-up results were satisfactory, and imaging follow-up demonstrated a high aneurysm occlusion rate. In summary, endovascular treatment of ruptured DIAs in the posterior circulation is feasible, safe, and effective, but attention should still be paid to the occurrence of related complications.