1001. The Treatment Strategy of Intracranial Paraclinoid Aneurysms

Authors: YuGang Jiang, MD; Yugang Jiang, MD (Changsha, China)

Introduction: To summarize the clinical experience of clipping and endovascular treatment of paraclinoid aneurysms. The follow-up result was used to explore the treatment strategy of paraclinoid aneurysms. Methods: Retrospective analysis of 27 patients with paraclinoid aneurysms treated with clipping and 19 patients treated with endovascular-therapy from March 2015 to July 2018. The data was collected from the Second Xiangya Hospital. Among those patients who had clipping, the Hunt-Hess grade was grade 5 in 5 cases, grade I in 7 cases, grade II in 13 cases, grade III in 1 case, and grade IV in 1 case. Postoperative CTA or DSA was performed to observe the aneurysm clipping. The result was evaluated by GOS at discharge. A total of 19 aneurysms were treated in 19 patients with endovascular treatment: 3 aneurysmal sac inner coil embolization; 13 stent-assisted coil embolization aneurysms; 3 covered stents completely covered. Results: 27 patients' aneurysms were all satisfactorily clipped. Postoperative DSA revealed no aneurysm recurrence. GOS ratings at discharge were 20 in grade V, 6 in grade IV, and 1 in grade III. All patients were followed up for 3-15 months. At the end of intervention in 19 patients with endovascular treatment, angiography showed that the aneurysm was not developed, the position of the stent was accurate, the blood flow in the stent was smooth, and there was no thrombotic event. All 19 patients who underwent endovascular treatment were followed up for 3-15 months. Conclusion: Proficiency of the anatomy is a prerequisite for all treatments. Clipping is suitable for most of the aneurysms at this segment. Interventional therapy is a first-line treatment. With the development of devices, the recurrence rate will be further reduced. There are no absolute criteria for the choice of surgical approach. It should be based on the surgeon's proficiency, and understanding of hemodynamics.