Result and experience of endovascular treatment for posterior circulation aneurysm at Bach Mai hospital

The objective of this study was to evaluate the results and experience of intravascular intervention for the treatment of a posterior circulation aneurysm in the Diagnostic Department at Bach Mai Hospital. This clinical intervention study was conducted with 60 patients with posterior circulation aneurysm with 60 aneurysms treated at Bach Mai Hospital from January, 2014 to January, 2018.

JOURNAL OF MEDICAL RESEARCH RESULT AND EXPERIENCE OF ENDOVASCULAR TREATMENT FOR POSTERIOR CIRCULATION ANEURYSM AT BACH MAI HOSPITAL Le Hoang Kien¹, Vu Đang Luu², Tran Anh Tuan¹, Nguyen Quang Anh², Nguyen Tat Thien¹, Nguyen Thi Thu Trang¹, Nguyen Huu An¹, Pham Minh Thong² ¹Bach Mai Radiology Center ²Hanoi Medical University The objective of this study was to evaluate the results and experience of intravascular intervention for the treatment of a posterior circulation aneurysm in the Diagnostic Department at Bach Mai Hospital This clinical intervention study was conducted with 60 patients with posterior circulation aneurysm with 60 aneurysms treated at Bach Mai Hospital from January, 2014 to January, 2018 The rutupred aneurysm early intervention with to days after the rupture onset 71.4 % Technical success was 100%, complete obliteration was 76.7%, while the residual neck was 6.8%, and the residual aneurysm was 8.9% Intervention technique of only using coils was 26.7% With a large aneurysm, coils + ballon assited accounted for 28.3%; 28,3% were treated with artery sacrifice method; 10 aneurysms are treated with flow diverter of 16.7% Patients with good recovery at the time of dischard is 85.4% (mRS 0-2) Endovascular intervention is a safe and effective method for posterior circulation aneurysm Keywords: Posterior circulation aneurysm, endovascular, coilling I INTRODUCTION Aneurysms of the posterior circulation system are less common than anterior circulation (about - 15%) depending studies [1 - 3] There are two main methods of treatment: surgical clipping of the aneurysm and endovascular treatment of the aneurysm Intravascular interventions Corresponding author: Le Hoang Kien, Bachmai Radiology Center Email: kienchandoanhinhanh@yahoo.com Received: 27/11/2018 Accepted: 12/03/2019 88 for aneurysm have rapidly replaced surgery for these lesions because of its high efficacy, decreased invasiveness, and increased safety [4] The following circulatory system is a separate group of clinical manifestations and treatments compared to the previous one Hemorrhage due to aneurysm rupture is more severe than bleeding due to previous rupture of the aneurysm with more severe clinical conditions at admission and higher mortality [3; 5; 6] In addition, the recurrence rate of rupture was higher than that of the previous one [2; 3] There are many options for intravascular intervention for posterior JMR 118 E4 (2) - 2019 JOURNAL OF MEDICAL RESEARCH aneurysm, depending on the location of the aneurysm, such as the basilar top, SCA, PICA, and the V4 segment of veterbarl artery: endovascular treatment of aneurysm with coils only or with supportive devices such as balloon or stent, artery sacrifice and with the more recent development of the flow diverter, we can achive occlusion of the aneurysm while preserving the artery [7] II METHODS Material 60 patients of posterior circulation aneurysm with endovascular treatment from January 2014 to January 2018 in the Department of Diagnostic Imaging Bach Mai Hospital Inclusion criteria Research site TAll of the patients were diagnosed with a posterioir aneurysm: * Unruptured aneuyrysm: Clinical symptoms, diagnostic with CHT 1.5 Tesla 3D TESLA (sequences TOF3D) or MDCTA, have been identified to detect posterior aneurysm, with indications for treatment that excludes the risk of rupture and clinical symptoms caused by aneurysm * Ruptured aneurysm: Patients with CT and MDCTA were found to rupture aneurysm with clinical status according to Hunt-Hess levels 1, and For Grade cases there was agreement with the clinicians Patients and / or families agree to treat by interventions Exclusion criteria JMR 118 E4 (2) - 2019 - Aneurysm at the feeding artery of arteriovenous malformation - Blood clotting disorder or allergy contrast medium - Hunt-Hess Study design Clinical description, unprotected intermittent follow-up, retrospective cohort study and clinical intervention Protocol technique - Patient preparation: Patients were fully informed about the benefits and risks of the intervention - Anesthesia: Patients are given anesthesia and anesthesia if co-ordinated, or if not, general anesthesia - Coilling only technique: The procedure was performed by two interventional electrothermal surgeons while patients were under local anesthesia or general anesthesia They placed a 6F sheathing device 7F at femoral artery must be when the balloon and the microcatheter are shared by the porteur - Anticoagulants: 2500 units of heparin were injected immediately when the device opened in the blood vessels and maintained 10 - 20 units / kg / h to have a blood coagulation time - times longer than normal - Insert the micro catheter (Echelon) into the center of the aneurysm, to drop the coils to fill the bulge of the aneurysm then withdraw the micro catheter - Balloon assisted coiling technique - Artery sacrifice technique 89 JOURNAL OF MEDICAL RESEARCH - Flow diverter technique - With fusiform, pseudo aneurysm or multi aneurysmsof verterbral artery, the patient was given a flow diverter before intervention which the patient is given an Asperigic 100mg double anticoagulant and a Plavix 75mg / day for days prior to intervention - Immediately after the intervention, the patient were immobilized, closely monitoring systemic conditions, blood pressure within 24 hours Statistical analytic Using SPSS 16 to analysis the data of the patients before and after the treatment The youngest patient was 19 and the oldest patient was 75 years old; The difference in age groups was not statistically significant, p = 0.17 Headache was the most common symptom All of patients with headache in the group rutupred aneurysm and 67% of patients in the group with unruptured aneurysm, in which the signs of ruptured is a sudden headache accounted for 82.2% In the study group (n = 60), 45 patients had COPD Patients with Hunt Hess level accounted for 53.3% of the group There was patient with severe SAH with Hunt & Hess level The majority of patients with posterior III RESULTS Patients The most common age group was 50 – 59 years old, accounting for 35% For both sexes the mean age was 53.18 ± 14.12 circulation aneurysm rupture in the study group had Fisher accounting for 75.3%, which indicates the severity of aneurysm rupture Table The rate of intraventricular haemorrhage with aneurysm ruptured (n = 45) n % Intraventricular haemorrhage 35 77,8 Progressive enlargement of ventricles 17 37,8 External Ventricular Drains after intervention 17,8 External Ventricular Drains before intervention 17,8 The rate of vertebral aneurysm in the study group was 38.3% and top basilar with 16 cases (26.7%) 90 JMR 118 E4 (2) - 2019 JOURNAL OF MEDICAL RESEARCH Table Vasopasm in study group Vasospam on DSA Aneurysm Total Normal Mild Moderate Severe Unrupture 14 (42,4) 0 (10,0) 15 (25,0) Rupture 19 (57,6) (100) 15 (100) (90,0) 45 (75,0) 33 15 10 60 Total p 0.003 The majority of posterior aneurysm have an average size of - 15mm, accounting for 73%; Aneurysm with a diameter of < 5mm accounted for 13.3%; Large size 15 - 25mm, accounting for 11.7% and giant ≥ 25mm, accounted for 1.7% When the aneurysm rupture with SAH, the rate and extent of spasm may increase depending on the level of blood flow and time before intervention 93% of unrupture aneurysm has no vasospasm Fisher had 18 patients with vascular occlusion (60%), including cases of severe spasms Results of treatment - Time of intervention: 88.9% of the aneurysms received intervention in to days from onset of rupture, 8.9% of the aneurysms received treatment in - 14 days; and 2.2% received intervention in more than days All of the unruptured aneurysms (n = 15) were treated by intervention - The main method treatment uses Coils only of aneurysm with narrow neck with neck < 4mm or neck / neck ratio > 1.5, accounting for 20/60 = 33,3% In the case of wide neck aneurysm, a balloon-assisted technique was used for 17/60 of the cases Flow diveter was used with 10 patients and 17 aneurysms were treated by artery sacrifice 28.3% The number of cases with complete occlusion was 76.7%, 16.6% had a residual neck and 6.7% had residual aneurysm - Complications during procedure JMR 118 E4 (2) - 2019 The success-rate of the techniques was 91.7% There were patients with protrustion of coils and one patient with thrombosis in artery at the neck of the aneurysm There was patient with stent displacement The patient was then treated again by using a supplementary stent One patient had an artery dissection There was patient with residual neck aneuyrysm with second rupture, which resulted in additional intervention serious clinical progression followed - Clinical recovery in mRS at discharge Patients who recovered well with mRS 0-2 accounted for 85.4% Low recovery with grade mRs accounted for 2.4%; 12.2% of irreversible patients had mRs Mean duration of hospitalization for the whole group of 60 patients was 7.12 ± 4.43, in which the unruptre group was 8.44 ± 4.31, the difference was statistically significant (p 91 JOURNAL OF MEDICAL RESEARCH