OBJECTIVE: To analyze the complications and long-term follow-up results of endovascular treatment for ruptured intracranial posterior circulation aneurysms and identify outcome predictors. METHODS: A total of 194 patients with ruptured intracranial posterior circulation aneurysms treated at our center between January 2014 and June 2023 were included in this retrospective analysis. Factors influencing complications during hospitalization and clinical and angiographic outcomes were analyzed. RESULTS: Complications occurred in 57 patients (29.4%) during hospitalization. The median clinical follow-up time was 46.5 (interquartile range 26.0-65.3) months, with favorable outcomes observed in 81.4% (158/194) and unfavorable outcomes in 18.5% (36/194) of cases, resulting in an overall mortality rate of 11.9% (23/194). The overall 1-year and 5-year complication-free survival rates were 76.4% and 70.7%, respectively. The overall 1-year and 5-year overall survival rates were 89.5% and 85.4%, respectively. Multifactorial analysis revealed that involvement of the basilar artery (P = 0.032) and perioperative external ventricular drainage (P <
0.001) were independent risk factors for complications during hospitalization, while advanced age (P = 0.030), poor World Federation of Neurosurgical Societies grade (P = 0.003), and use of closed cell design laser cut stents (P = 0.041) were independent risk factors for unfavorable outcomes during follow-up. Among the survivors, angiography follow-up was available for 139 patients, with a follow-up rate of 81.3% (139/171) and a median follow-up time of 8 months (interquartile range 6-12). During this period, 9 patients experienced aneurysm recanalization, and the complete occlusion rate was 85.6% (119/139). CONCLUSION: Endovascular treatment is feasible and effective for treating ruptured intracranial aneurysms
however, there are still risks of complications and unfavorable clinical outcomes. The involvement of the basilar artery trunk increases the risk of complications, and the use of closed cell design laser cut stents is associated with unfavorable outcomes. Clinicians should be cautious to avoid the risk factors when treating ruptured posterior circulation aneurysms and strive to minimize the occurrence of complications and unfavorable clinical outcomes.