DOI: N/A
*Hasan ATMH, Rahman KM, Khan SU, Islam SS4, Shaikat AUR, Nuzhat E, Rahman MH, Hossain MA, Chowdhury RA, Raknuzzaman M, Sarker MHK, Rassel MA, Khan PA, Amin SMA, Khan MA, Paul P, Hasanat MA, Alam MB, Mohammad QD
Background: Although adjunctive techniques like stent/ flow diverters, or balloon-assisted techniques have become popular over last two decades, unassisted coil embolization remains a simple minimalist strategy, particularly in resource poor settings. But the safety and efficacy data from a real-world low-income country is very limited. This study was done to evaluate the long-term clinical outcomes of unassisted endovascular coil embolization in a large cohort of intracranial aneurysms treated at a single center by a single interventional neurologist.
Methods: This was an ambi-directional cohort study. We retrospectively have analyzed 235 intracranial aneurysms treated with unassisted coil embolization between January 2021 to December 2024. Demographic data, aneurysm characteristics, procedural details, complications, and clinical outcomes were reviewed. Mid-term follow-up clinical outcomes were evaluated using the modified Rankin Scale (mRS) at 12 months prospectively.
Results: A total of 235 aneurysms from 221 patients were selected for analysis according to inclusion criteria. Around two third of the patients (61%) were aged greater than 50 years with a mean age of 50.34 (±16.1) years and a male to female ratio were 1:2.25. Most common symptoms at presentation were sudden severe headache (90.9%), vomiting (35.7%), loss of consciousness (32.1%) and altered sensorium (28.1%). More than half of the patients (52.9%) had a WFNS grade of 1 and around 43.4% patients had modified fisher grade of 4. Around three fourth (75.2%) were small to medium sized that is from 3 mm to 10 mm with majority being narrow necked (70.8%). Most of the aneurysms (88.9%) were in anterior circulation of which Anterior communicating artery (AcoM) aneurysms (18.7%) and posterior communicating artery (PcoM) aneurysms (16.6%) were the most common. Among the posterior circulation aneurysms, Basilar tip was the most frequent location found in 11 patients, followed by posterior cerebral artery aneurysm in 5 patients. RROC class 2 and 1 were achieved among majority of the patients (94.4%). The rate of procedural complications was 9.4% (22 events) among which intraprocedural rupture of aneurysms was the most common event (3.4%), followed by thromboembolic complications in 2.9%. Majority of the patients (86.8%) had favorable outcome (mRS 0-2) at at 12 months. Total number of deaths at follow up were 10 (4.5%).
Conclusion: Unassisted endovascular coil embolization is a safe and effective treatment for selected intracranial aneurysms, providing durable long-term occlusion with acceptable complication and retreatment rates. A single-performer experience highlights the importance of patient selection and technical consistency in achieving favorable outcomes.