1159. Non-Saccular Aneurysms: A Wide Analysis of 42 Aneurysms

Authors: Enrico Affonso Barletta; Telmo Belsuzarri; João Araújo; Maick Neves; José Aquino (São Paulo, Brazil)

Introduction:
Non-saccular aneurysms are a special entity, present particular natural history and prognosis. Literature presents few number of studies.


Methods:

Retrospective, observational analytic, transversal and longitudinal study, analyzing 37 patients and 42 non-saccular aneurysms (23 fusiform, 12 dissecting, 4 mycotic and 3 blister).

Results:

Fusiform: 10 at anterior circulation, 13 in posterior. 3 at Communicating Internal Carotid Artery (ICA), 2 Supraclinoid ICA, 1 Cavernous ICA, 4 Anterior Communicating Complex, 4 V4 Segment, 4 Vertebro-Basilar Junction and 5 Basilar Artery.

Dissecting: 8 at anterior circulation, 4 posterior. 3 at Right ICA, 4 Left ICA, 1 Left Middle Cerebral Artery (MCA), 3 Right Vertebral Artery (VA) and 1 Left Posterior-Inferior Cerebellar Artery.

Mycotic: 3 at anterior circulation, 1 at posterior

Blister: 3 at ophthalmic ICA.

7 fusiform, 6 dissecting and 3 mycotic aneurysms measured, average size: 12,14mm; 13,16 mm; 5,5mm.

  Hunt & Hess (HH) and Fisher scale of 6 fusiform, 4 dissecting and 1 mycotic aneurysms, mean HH 3,18; 45,4% scored 5. Mean Fischer 3,54; 72,7% scored 4.

         6 dissecting and 2 fusiform treated. 6 coiled, 1 total excluded and 5 presented residual neck, 4 treated again: 2 coiled (1 total excluded and 1 residual aneurysm), 1 stent-assisted coiling and 1 treated with balloons and coiling (both total excluded). 2 flow diversions with FRED, both total excluded.

Conclusion:

Fusiform are the most recurrent, more present at posterior circulation, VA is the most affected artery. Dissecting are more present at the anterior circulation, ICA is the most affected. Mycotic are more present at the anterior circulation. 100% of blister were at ophthalmic ICA. Increased size is a mark of non-saccular. Ruptured non-saccular originates more severe hemorrhages. 50% requested a second treatment, 75% were totally excluded, All flow diversions resulted in total exclusion.