الفهرس 
Acknowledgement
AIM OF THE WORKOnly 14 pages are availabe for public view
 |  | from | 195 |  |  |
| | | from | 195 | | |
Abstract
Despite advances in endovascular treatment methods, wide neck aneurysms are the most difficult to treat. In this study we evaluate the efficacy and safety of the endovascular treatment of intracranial wide neck saccular aneurysms as regard radiological and clinical outcome.
Our study includes 40 patients, have either rupture or unruptured WNAs who underwent endovascular intervention in the period between March 2019 and February 2021, in addition to patients who underwent these modalities of treatment in the past five years. Interventional procedures were done in the neuro-endovascular unit, Assuit University Hospital and Ain Shams University Hospital.
This study included 22 male (55%) and 18 females (45%) with male to female ratio being 1.2:1. The mean ages of the patients were of 51.3±8.9 years. Four patients who involved in the study are diabetics on regular antidiabetics, seven patients were hypertensive and two patients have mild renal impairment with creatinine level >2 mg/dl.
All 40 patients (100%) were symptomatic. One patient(2.5%) presented with mass effect as third cranial nerve palsy, 16 patients (40%) presented with headache and 23 patients (57.5%) presented with acute aneurysmal rupture, inform of sudden severe headache and neck stiffness.
The mean of the preprocedural mRS, clinical assessment of patients, was 0.68±1.07. The modified Fisher grade was grade 1 in ten patients, grade 2 in five patients, and grade 3 in eight patients.
The mean aneurysmal height was 4.87 mm (SD +/- 2.07), the dome was 4.58 mm (SD +/- 2.64) and the neck was 3.36 mm (SD +/- 1.58). Thirty-five aneurysms (87.5 %) were in the anterior circulation and 5 aneurysms (12.5 %) located at posterior circulation.
Five methods of endovascular treatment were used for our patients. Three patients (7.5%) were treated with simple coiling, 5 patients (12.5%)were treated with double catheter technique, 16 patients (40%) was treated with BAS, 13 patients (32.5%)were treated with SAC and 3 patients (7.5%) were treated with FD.
The sequllae of SAH were ventriculomegaly, in four patients, which resolved spontaneously. Post SAH vasospasm occurred, in 6 patients, which complicated with stroke in only two patients. Regarding treatment related complications, groin hematoma occurred in two patients, vasospasm in three patients, coil migration in one patient, thrombus formation in one patient and herniated coil in one patient.
Regarding post interventional Clinical outcome, the mean of the immediate post-procedural mRS (after one month) was 0.58±0.931; twenty six patients (65%) had mRS0; eight patients (20%) had mRS1; three patients (7.5%) had mRS3; three patients (7.5%) had mRS4.
The mean of final clinical outcome mRS(after one year) was of 0.28±0.599; thirty two patients (82.5 %) had mRS0; five patients (10 %) had mRS1; three patients (7.5 %) had mRS2. The P value of the difference between mRS means of patients before the treatment and after one year of treatment is 0.008 which has a highly significance statistically.
Regarding radiological outcomes, immediate angiographic follow-up showed 36 patients (90%) with Raymond-I and 1 patient (2.5%) who was treated with simple coiling showed Raymond-II necessitating and needed further management with stent-assisted technique.
The remaining three aneurysms (7.5%) were treated with FD and showed complete occlusion (OKM Grade D). One year of angiographic follow-up showed 34 patients (85%) with Raymond-I, 2 patients (5%) with Raymond-II, and 1 patient (2.5%) with Raymond-III. The patients who were treated with FD were also revealed complete occlusion (OKM Grade D) at after one-year follow-up.
In conclusion, wide-necked aneurysms remain difficult to be treated and occluded permanently. In some cases, endovascular treatment is the only possible option for treatment of the wide neck aneurysms. According to our experience, despite some troubles during the treatment, endovascular treatment of intracranial wide neck aneurysms was revealed safe and feasible. Due to the introduction of new flow modification devices, further studies with bigger sample size and longer follow-ups are required to approve their effectiveness in the treatment of WNAs.