ArticleNeurosurgical review2026
Endovascular treatment of basilar apex aneurysms: A bi-institutional case series and exploratory pulsatile computational fluid dynamic analysis.
Article in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundBasilar apex aneurysms (BAAs) pose a challenge due to their deep location, critical neurovascular structures, and higher rupture risk compared to anterior circulation aneurysms. This case series aimed to evaluate morphological factors associated with recurrence after endovascular treatment (EVT) and explore hemodynamic factors using pulsatile computational fluid dynamics (CFD) simulations.
methodsRetrospective analysis of patients with BAAs receiving EVT at two academic centers from January 2011 to June 2024 was completed. Data collected included occlusion status (using the Raymond-Roy Occlusion Classification; RROC), recurrence (angiographic worsening in degree of occlusion), and aneurysm characteristics included wide neck (yes or no if diameter ≥ 4 mm), high aspect ratio (yes or no if ≥ 1.6), and packing density (low if < 20%). Pulsatile CFD simulations were integrated in five consecutive eligible cases to describe hemodynamic factors associated with recurrence.
results21 patients, 85.7% female; mean age 63.2 years with single BAA were included in this analysis. Endovascular treatments included coil embolization alone (3 cases), balloon-assisted coiling (BAC; 1), stent-assisted coiling (SAC; 10), Y-stent coiling (4), and WEB embolization (3). The median follow up was 29 months. Five patients experienced recurrence during the time of follow up (2 treated with coils, 1 treated with SAC, 1 treated with BAC and 1 with Y-stent), with three requiring re-treatment. Among the 5 recurrent aneurysms, 4 had a high aspect ratio, 3 were associated with a wide neck, 2 were ruptured at initial presentation, and 1 exhibited low packing density. High aspect ratio was associated with an increased likelihood of recurrence on univariate analysis (p = 0.046). Exploratory CFD analysis showed that among the 5 aneurysms analyzed, the one that recurred had a higher OSI (0.043 vs. 0.027 ± 0.015), increased WSS pulsatility index (2.63 vs. 2.21 ± 0.39), and a greater inflow ratio (0.99 vs. 0.76 ± 0.21) compared to the average of the four aneurysms that did not recur.
conclusionsDurable occlusion was achieved in most endovascular interventions, except for primary coiling, in which both aneurysms with follow-up recurred. Recurrence was significantly associated with high aspect ratio in this small cohort. Exploratory analysis showed higher OSI and inflow ratio in the aneurysm that recurred within the illustrative subgroup analyzed using CFD.
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