Real-World Outcomes of Endovascular Management of Intracranial Aneurysms: Insights from a Tertiary Care Hospital in Central India

Abstract

Purpose

Endovascular coiling has emerged as a preferred treatment for intracranial aneurysms (IAs), offering better functional outcomes than surgical clipping. This study examines the demographic and clinical profiles of patients with IAs, evaluates the success of various endovascular techniques, and reports associated complications in a publicly funded tertiary care hospital in Central India.

Methods

This retrospective study included 100 patients (103 aneurysms) treated from March 2021 to December 2023. Data on aneurysm morphology, rupture status, and treatment modality were analyzed. Procedures included simple coiling, balloon-assisted coiling, stent-assisted coiling, flow diverters, and braided stent monotherapy. Outcomes were assessed using the modified Rankin Scale (mRS) and angiographic Modified Raymond–Roy Classification. Complications like vasospasm and thromboembolic events were recorded, and linear regression was used to identify factors influencing outcomes.

Results

Aneurysms were mostly saccular (91%) and located in the anterior circulation (83.5%). Favorable outcomes (mRS 0–2) were achieved in 81.5% of patients at discharge, with 91.7% maintaining functional independence during follow-up (3 months to 2 years).

Complications included thromboembolic events (6.5%), intraoperative rupture (1.9%), and coil migration (1%). Complete aneurysm occlusion was achieved in 74.4% of cases available for angiographic follow-up. Poor outcomes were associated with high World Federation of Neurosurgical Societies grade, vasospasm, and thromboembolic events. Mortality was 14.1%.

Conclusion

Endovascular coiling is effective in achieving functional independence and aneurysm occlusion, comparable to global standards. However, complications like vasospasm and thromboembolic events emphasize the need for individualized care and long-term follow-up in resource-limited settings.

Keywords

coiling - aneurysm - endovascular

Ethical Approval

The study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed Consent

Informed consent was gathered from the patient and consent to publish images was obtained.

Publikationsverlauf

Artikel online veröffentlicht:
29. Juli 2025

• References

• 1 Molyneux AJ, Kerr RS, Yu LM. et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005; 366 (9488): 809-817
• 2 Laurent D, Lucke-Wold B, Leary O. et al. The evolution of endovascular therapy for intracranial aneurysms: historical perspective and next frontiers. Neurosci Insights 2022 17. :26331055221117560
• 3 Phillips TJ, Mitchell PJ. Endovascular treatment of intracranial aneurysms. Imaging Med 2010; 2 (06) 633-657
• 4 Yadav N, Kumar A, Hedaoo K, Jain A, Singh K, Vikram A. Establishing a new neurointerventional facility in a remote area of a low-middle income country (LMIC): initial experience. Asian J Neurosurg 2022; 17 (01) 50-57
• 5 McDougall CG, Spetzler RF, Zabramski JM. et al. The barrow ruptured aneurysm trial. J Neurosurg 2012; 116 (01) 135-144
• 6 Lanzino G, Murad MH, d'Urso PI, Rabinstein AA. Coil embolization versus clipping for ruptured intracranial aneurysms: a meta-analysis of prospective controlled published studies. AJNR Am J Neuroradiol 2013; 34 (09) 1764-1768
• 7 Campi A, Ramzi N, Molyneux AJ. et al. Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 2007; 38 (05) 1538-1544
• 8 Pierot L, Barbe C, Nguyen HA. et al. Intraoperative complications of endovascular treatment of intracranial aneurysms with coiling or balloon-assisted coiling in a prospective multicenter cohort of 1088 participants: Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) study. Radiology 2020; 295 (02) 381-389
• 9 Pierot L, Cognard C, Anxionnat R, Ricolfi F. CLARITY Investigators. Ruptured intracranial aneurysms: factors affecting the rate and outcome of endovascular treatment complications in a series of 782 patients (CLARITY study). Radiology 2010; 256 (03) 916-923
• 10 Pierot L, Spelle L, Vitry F. ATENA Investigators. Immediate clinical outcome of patients harboring unruptured intracranial aneurysms treated by endovascular approach: results of the ATENA study. Stroke 2008; 39 (09) 2497-2504
• 11 Cognard C, Pierot L, Anxionnat R, Ricolfi F. Clarity Study Group. Results of embolization used as the first treatment choice in a consecutive nonselected population of ruptured aneurysms: clinical results of the Clarity GDC study. Neurosurgery 2011; 69 (04) 837-841 , discussion 842
• 12 White PM, Lewis SC, Nahser H, Sellar RJ, Goddard T, Gholkar A. HELPS Trial Collaboration. HydroCoil Endovascular Aneurysm Occlusion and Packing Study (HELPS trial): procedural safety and operator-assessed efficacy results. AJNR Am J Neuroradiol 2008; 29 (02) 217-223
• 13 van Rooij WJ, Sluzewski M, Beute GN, Nijssen PC. Procedural complications of coiling of ruptured intracranial aneurysms: incidence and risk factors in a consecutive series of 681 patients. AJNR Am J Neuroradiol 2006; 27 (07) 1498-1501
• 14 Orrù E, Roccatagliata L, Cester G, Causin F, Castellan L. Complications of endovascular treatment of cerebral aneurysms. Eur J Radiol 2013; 82 (10) 1653-1658
• 15 Elijovich L, Higashida RT, Lawton MT, Duckwiler G, Giannotta S, Johnston SC. Cerebral Aneurysm Rerupture After Treatment (CARAT) Investigators. Predictors and outcomes of intraprocedural rupture in patients treated for ruptured intracranial aneurysms: the CARAT study. Stroke 2008; 39 (05) 1501-1506
• 16 Renowden SA, Beneš V, Bradley M, Molyneux AJ. Detachable coil embolisation of ruptured intracranial aneurysms: a single center study, a decade experience. Clin Neurol Neurosurg 2009; 111 (02) 179-188
• 17 Park YK, Yi HJ, Choi KS, Lee YJ, Chun HJ. Intraprocedural rupture during endovascular treatment of intracranial aneurysm: clinical results and literature review. World Neurosurg 2018; 114: e605-e615
• 18 Kassell NF, Sasaki T, Colohan AR, Nazar G. Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 1985; 16 (04) 562-572
• 19 Harrod CG, Bendok BR, Batjer HH. Prediction of cerebral vasospasm in patients presenting with aneurysmal subarachnoid hemorrhage: a review. Neurosurgery 2005; 56 (04) 633-654 , discussion 633–654
• 20 Molyneux AJ, Birks J, Clarke A, Sneade M, Kerr RSC. The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet 2015; 385 (9969): 691-697
• 21 Klompenhouwer EG, Dings JTA, van Oostenbrugge RJ, Oei S, Wilmink JT, van Zwam WH. Single-center experience of surgical and endovascular treatment of ruptured intracranial aneurysms. AJNR Am J Neuroradiol 2011; 32 (03) 570-575
• 22 Gudelj M, Bruyère PJ, Tebache M, Collignon L, Lubicz B. Endovascular treatment of intracranial aneurysms: initial experience in a low-volume center. J Belg Soc Radiol 2020; 104 (01) 19
• 23 Elewa MK. Endovascular coiling for cerebral aneurysm: single-center experience in Egypt. Egypt J Neurol Psychiatr Neurosurg 2018; 54 (01) 33