• Nohra Chalouhi, Pascal Jabbour, L Fernando Gonzalez, Aaron S Dumont, Robert Rosenwasser, Robert M Starke, David Gordon, Shannon Hann, and Stavropoula Tjoumakaris.
• Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania 19107, USA.
• Neurosurgery. 2012 Oct 1; 71 (4): 785-94.

BackgroundEndovascular therapy is now the preferred treatment option for basilar tip aneurysms (BTAs).ObjectiveTo compare the safety and efficacy of common endovascular techniques in the treatment of BTAs.MethodsA retrospective review was conducted of 235 patients with BTAs treated with endovascular means in our institution between 2004 and 2011. Categorization was based on the presence and type of stent assistance (none, single, and Y stenting). The rates of perioperative complications, recanalization, rehemorrhage, and retreatment were analyzed.ResultsA total of 147 patients were treated with coil embolization and 88 patients with stent-assisted coiling (72 single stents, 16 Y stents). Thromboembolic complications occurred in 6.8% of patients in both groups. There was no associated mortality. Angiographic follow-up (mean, 23.5 months) was available in 172 patients (77.1%). Stented patients had significantly lower recanalization (17.2% vs 38.9%; P=.003) and retreatment (7.8% vs 27.8%; P=.002) rates compared with nonstented patients. Four rehemorrhages (2.7%) occurred in the coiled group, whereas none were noted in the stented group (P=.3). In paired comparisons, lower recanalization (8.3% vs 19.2%; P=.21) and retreatment (0% vs 9.6%; P=.19) rates were seen in the Y-stent group compared with the single-stent group. Thromboembolic complications occurred in 6.9% and 6.2% of patients in the single-stent and Y-stent groups, respectively (P=.91). In multivariate analysis, larger aneurysms, nonstented aneurysms, incomplete initial occlusion, and subarachnoid hemorrhage were predictors of aneurysm recanalization.ConclusionStent-assisted coiling has significantly lower recurrence, retreatment, and rehemorrhage rates than coiling alone for the treatment of BTAs. Y stenting has the highest efficacy with low complication rates.

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