• 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 Dec 5; 194: 123473123473.

ObjectiveAssess the complications, clinical outcomes, and angiographic results of endovascular treatment (EVT) for 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 EVT. The study examined risk factors associated with in-hospital complications and clinical outcomes.ResultsThe incidence of in-hospital complications among all patients receiving reconstructive EVT was 30.4% (24/79). The median clinical follow-up time of the patients was 45 months (interquartile range: 28-65 months). Favorable clinical outcomes were observed in 83.5% (66/79) of patients, while the overall mortality rate was 11.4% (9/79). Of the 75 survivors, 59 (78.7%) underwent angiographic follow-up, revealing a median follow-up time of 11 months (interquartile range: 6-12 months) and a complete occlusion rate of 84.7% (50/59). Residual aneurysms occurred in 6.8% (4/59) of patients. Survival analysis indicated 1- and 3-year complication-free survival rates of 70.9% and 65.5%, respectively, and overall 1- and 3-year survival rates of 89.6% and 87.6%. Multivariate analysis identified external ventricular drainage (P = 0.007) as an independent risk factor for in-hospital complications. Older age (P = 0.024) and a World Federation of Neurosurgical Societies grade of 4-5 (P < 0.001) were independent risk factors for unfavorable clinical outcomes.ConclusionsReconstructive EVT for ruptured intracranial posterior circulation small artery aneurysms was generally safe and effective. However, the risk of complications and unfavorable clinical outcomes persisted. External ventricular drainage was a significant risk factor for in-hospital complications, whereas older age and higher World Federation of Neurosurgical Societies grades were predictors of unfavorable clinical outcomes.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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