Endovascular treatment for unruptured intracranial aneurysms with moderate to severe parent artery stenosis: a retrospective study

Endovascular treatment of unruptured intracranial aneurysms (UIAs) becomes particularly challenging when they are associated with moderate to severe parent artery stenosis. This study aimed to summarize and analyze a proposed treatment strategy to provide a valuable reference for clinical practice. Patients with UIAs and moderate to severe parent artery stenosis who underwent endovascular treatment were retrospectively enrolled. An interventional protocol focusing on this proposed treatment strategy was implemented. A comprehensive summary and analysis of the patient characteristics, imaging data, outcomes, and complications were conducted. A total of 96 patients were included. Among these, 93 patients underwent single-stage treatment, whereas the remaining 3 underwent staged treatment. Primary endovascular techniques included coiling, stent-assisted coiling, and flow diverter placement. Adjunctive balloon angioplasty, performed either before or after embolization, was utilized in specific cases. The results demonstrated that the proposed strategies could be effectively and rationally customized according to aneurysm characteristics and the severity of parent artery stenosis. At the 6-month follow-up, in-stent restenosis was observed in 11 patients (11.5%), ischemic events occurred in 7 patients (7.3%), and cerebral hemorrhage was noted in 1 patient (1%). Additionally, pre-dilation before embolization may be associated with a trend toward reduced in-stent restenosis and ischemic events. Our findings indicate that the proposed interventional strategy, based on aneurysm and stenosis characteristics, is effective and safe for UIAs with moderate to severe parent artery stenosis. Nevertheless, these preliminary findings warrant confirmation through larger-scale, more rigorous prospective studies.