1203. Riskier-Than-Expected Occlusive Treatment of Ruptured Posterior Communicating Artery Aneurysms: Treatment and Outcome of 620 Consecutive Patients

Authors: Justiina Huhtakangas; Martin Lehecka, MD, PhD; Hanna Lehto, MD, PhD; Behnam Rezai Jahromi, MD; Mika Niemelä, MD, PhD; Riku Kivisaari, MD, PhD (Helsinki, Finland)

Introduction Occlusive treatment of posterior communicating artery (PComA) aneurysms has been seen as a fairly uncomplicated procedure. The objective was to determine the radiological and clinical outcome of patients after PComA aneurysm rupture and treatment, and to evaluate risk factors for impaired outcome. Methods Data were collected from 620 consecutive patients with ruptured PComA aneurysm, treated at a single center between 1980 and 2014. The follow-up was a minimum of 1year, or until death. Results Of the 620 patients, 83% were treated by microsurgical clipping and 8% by endovascular coiling, 2% with combined, 1% with indirect surgical methods and 6% conservatively. The m ost common procedural complications were treatment-related brain infarctions (15%). The amount of artery occlusions (10% microsurgical, 8% endovascular) was higher than expected. Most of the patients made a good recovery at 1year after aneurysmal subarachnoid hemorrhage (mRS0-2 n=386, 62%). A fairly small proportion of patients were left severely disabled (mRS4-5 n=27, 4%). Of all, 20% died during the first year. Independent risk factors for unfavorable outcome, according to the multivariable analysis, were poor preoperative clinical condition, ICH or SDH due to aneurysm rupture, age over 65, artery occlusion in postoperative angiography, occlusive treatment related ischemia, delayed cerebral vasospasm and hydrocephalus requiring a shunt. Conclusion Even though most patients made a good recovery after a PComA aneurysm rupture and treatment during the first year, the occlusive treatment related complications were higher than expected and caused morbidity also among initially good grade patients. Occlusive treatment of ruptured PComA aneurysm seems to be a high-risk procedure, even in a high-volume neurovascular center.