Abstract：Objective To investigate the safety and efficacy of endovascular treatment for wide-necked intracranial aneurysms concomitant with severe parent artery stenosis.Methods Fourteen patients (5 male and 9 female, aged 45-76[(61.07±10.43)] years) with 14 wide-necked intracranial aneurysms concomitant with severe parent artery stenosis who underwent endovascular treatment at the Department of Cerebrovascular Disease of Zhengzhou University People's Hospital from January 2017 to December 2019 were retrospectively enrolled in this study. Among the 14 patients, 8 harbored ruptured aneurysms and 6 harbored unruptured aneurysms. The median of preprocedural parent artery stenosis rate was 70% (70%-90%). According to the location of stenosis and aneurysm, the lesions were classified into types Ⅰ(9 cases), Ⅱ(4 cases), and Ⅲ(1 cases). The Raymond grading scale was used to evaluate the aneurysm occlusion, and the modified Rankin scale (mRS) was used to evaluate clinical status.Results Stenosis was treated prior to the stent- assisted coiling of the aneurysm, and the procedure were successful in 14 patients. Immediately after the procedure, complete occlusion (grade Ⅰ of Raymond grading scale) was observed in 12 aneurysms, and entry remnant (grade Ⅱ) was observed in 2 aneurysms. The median of postprocedural parent artery stenosis rate was 25% (20%-30%). Clinical follow-up was performed in all 14 patients at 3 months, and the mRS scores were 0 in 12 patients, 2 in one patient, and 3 in one patient. A total of 11 patients received imaging follow-up at a median of 6.45 (6-10) months. Digital subtraction angiography(DSA) showed that complete occlusion (grade Ⅰ of Raymond grading scale) in 10 aneurysms, and entry remnant (grade Ⅱ) in 1 aneurysm. In-stent restenosis or occlusion was not observed in all 11 patients.Conclusions Treating the stenosis of the parent artery first followed by the coiling of aneurysms is a safe and effective approach for wide-necked intracranial aneurysms concomitant with severe parent artery stenosis. Long-term follow-up studies with large sample sizes are needed.
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2021, Vol. 26 
