PDF icon Download PDF
Open Access
CC BY 4.0 · Journal of Clinical Interventional Radiology ISVIR
DOI: 10.1055/s-0045-1810087
Original Article

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

Nishtha Yadav 
1   Department of Neuroradiology, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Ketan Hedaoo 
2   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Jayant Patidar 
2   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Vijay Singh Parihar 
2   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Shailendra Ratre 
2   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Aparna Tamaskar
3   Department of Anaesthesia, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Anivesh Jain
3   Department of Anaesthesia, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Saranya Ravi
4   Department of Radiology, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Vinayak Mahajan
2   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Amar Pratap Singh
2   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
› Author Affiliations
Funding None
› Further Information
Also available ateRefMedOne
  Permissions and Reprints
Preview

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.




Publication History

Article published online:
29 July 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 3 Phillips TJ, Mitchell PJ. Endovascular treatment of intracranial aneurysms. Imaging Med 2010; 2 (06) 633-657
    CrossrefPubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 McDougall CG, Spetzler RF, Zabramski JM. et al. The barrow ruptured aneurysm trial. J Neurosurg 2012; 116 (01) 135-144
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 18 Kassell NF, Sasaki T, Colohan AR, Nazar G. Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 1985; 16 (04) 562-572
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 23 Elewa MK. Endovascular coiling for cerebral aneurysm: single-center experience in Egypt. Egypt J Neurol Psychiatr Neurosurg 2018; 54 (01) 33
    CrossrefPubMedSearch in Google Scholar