Endovascular Treatment of Basillary Tip Aneurysms

Objective: To determine the efficacy and safety of endovascular treatment of basillary tip aneurysms and review the literature. Materials and Methods: There was a total of 30 patients between 16-71 years old, 15 males, 15 females. 19 (63.3%) patients had subarachnoidal haemorhage and 11 (36.7%) had no bleeding. There was at least one additional aneurysm, other than basillary tip, in 11 patients. Dual antiagregant treatment was started 7-10 days before the treatment with stenting. Patients were checked with Diffusion MR after 24 hours, then followed by DSA at 3-6th and 18th months. Results: Procedure was successful in all patients. Coils were used in 29 patients. In 18 patients there was not any need for stenting; however 11 of those were treated with balloon asisted. Remaining 12 patients were treated with stenting. Additionally, two patients were stented because of recanalization during follow-up. In 10 patients Y stenting with coiling, in two single stent with coiling and in three telescopic stenting without coiling were used. In three patients distal arterial rupture occured but the patients recovered without any neurologic sequela. In seven patients trombus formation occured during procedure and they were treated with IV tirofiban. Two patients had permanent and one patient had temporary hemiparesis. One patient died probably due to thromboembolism. One of two patients whose Hunt and Hess grade was five, died after 10 days of procedure and the other died after four years of vegetative state. Another patient with grade four died after 3 years later due to sepsis. Peroperative severe morbidity was 7.1%, mortality related with the procedure was 3.6% excluding patients whose Hunt and Hess score was five. Conclusions: Endovascular treatment of basillary tip aneurysms is an effective and safe method. Despite endovascular therapy, mortality and morbidity are still high in patients with high Hunt and Hess scores. Key Words:Intracranial aneurysm, Intracranial stent, Endovascular embolization, Endovascular treatment, Basillary tip aneurysm.