gms | German Medical Science

Objective: Aneurysms of the internal carotid artery (ICA) bifurcation are rare and no studies have compared patient outcomes after endovascular vs. surgical treatment. Here, we report the safety, efficacy, and follow-up outcome of these two treatment options for patients with ICA-bifurcation aneurysms.

Method: Patient information, aneurysm characteristics (size, projection and configuration), treatment results, and follow-up outcomes (at 30 months) were analyzed. Projections were defined as medially, laterally, superiorly, posteriorly and anteriorly. The configuration was divided in two groups: aneurysm, which originating only from the ICA-bifurcation, and aneurysms, which involving proximal A1-/M1-segment. If the aneurysm neck is located directly within the blood flow of the ICA and not partially involving the proximal A1- or M1-segment, we defined this aneurysms as “originating only from the ICA-bifurcation”.

Results: We treated a total of 58 patients with ICA-bifurcation between 1999 and 2012 including ruptured and unruptured aneurysms; 30 were assigned to coiling, and 28 were assigned to clipping. Patients who underwent surgical clipping were younger and had larger aneurysms than patients who underwent endovascular coiling. More patients were assigned to endovascular treatment if their aneurysms originated only from the ICA-bifurcation or projected superiorly. The near complete occlusion rate in endovascular treated patients was high (96%). Except for small neck remnants (to keep perforators open and to prevent A1- or M1-stenosis) all aneurysms could be clipped completely. At follow-up the recanalization rate after coiling was 46%. Multivariate analysis revealed that an aneurysm originating only from the ICA-bifurcation was an independent predictor of recanalization after coiling.

Conclusions: To our knowledge, this is the first report directly comparing outcomes of endovascular coiling and surgical treatment for ICA-bifurcation aneurysms. Our findings indicate that, when an aneurysm originates only from the ICA-bifurcation, the surgical treatment in experienced hands may be preferred over endovascular treatment.