• Jinshuo Yang, Qiaowei Wu, Chunlei Wang, Zhiyong Ji, Pei Wu, Guang Zhang, Chao Xu, Jiaxing Dai, Chunxu Li, Yujing Zhu, Shancai Xu, and Huaizhang Shi.
• Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
• World Neurosurg. 2024 Nov 20.

ObjectiveAssess the complications, clinical outcomes, and angiographic results of ruptured intracranial posterior circulation aneurysms in small arteries, and identify their risk factors.MethodsWe conducted a retrospective analysis of 79 patients with ruptured posterior circulation aneurysms in small arteries (the diameter of the parent artery was ≤2 mm) treated at our hospital between January 2014 and August 2023. All patients received endovascular treatment. The study examined risk factors associated with in-hospital complications and clinical outcomes.ResultsThe incidence of in-hospital complications among all patients receiving reconstructive endovascular treatment was 12.7% (10/79). The patients were followed up for a median of 45 months (IQR 28-65), with an overall complication rate of 38.0%. Favorable clinical outcomes were observed in 85.3% (66/79) of patients, while the mortality rate was 11.4% (9/79). Of the 70 survivors, 59 (84.3%) underwent angiographic follow-up, revealing a median follow-up time of 11 months (IQR 6-12) and a complete occlusion rate of 84.7% (50/70). Aneurysm recanalization occurred in 6.8% (4/59) of patients. Survival analysis indicated 1-year and 3-year complication-free survival rates of 70.9% and 65.5%, respectively, and overall 1-year and 3-year survival rates of 89.6% and 87.6%. Multivariate analysis identified surgery within 72 hours of onset (p=0.043) and external ventricular drainage (p=0.023) as independent risk factors for in-hospital complications. Older age (p=0.024) and a WFNS grade of 4-5 (p<0.001) were independent risk factors for unfavorable clinical outcomes.ConclusionReconstructive endovascular treatment for ruptured intracranial posterior circulation small artery aneurysms is generally safe and effective. However, the risk of complications and unfavorable clinical outcomes persists. Early surgery within 72 hours post-rupture and external ventricular drainage are significant risk factors for in-hospital complications, whereas older age and higher WFNS grades are predictors of poor clinical outcomes.Copyright © 2024. Published by Elsevier Inc.

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