Endovascular treatment of ruptured vertebral artery dissecting aneurysms

Byungjun Kim, Nam-Joon Lee, Keonha Kim, Kyung Il Jo, Pyoung Jeon

Research output: Contribution to journalArticle

Abstract

Background: Various endovascular treatment methods have been used to treat ruptured vertebral artery dissecting aneurysms (VADAs). However, the efficacy and long-term durability of the various endovascular techniques have remained unestablished. Objectives: The purpose of the present study is to report the therapeutic efficacy and long-term clinical and angiographic results of various endovascular treatment methods, and to evaluate the predictive factors of favorable outcomes. Patients and Methods: Between January 2010 and August 2014, 30 patients with ruptured VADAs were classified according to the dominancy of the affected vertebral artery (VA) and the involved major perforating vessels. Allotted endovascular therapy was performed for each of the ruptured VADA subtypes. Immediate angiographic and follow-up imaging results were retrospectively reviewed, and long-term clinical results were evaluated. Various clinical, angiographic, and procedural factors were evaluated to determine their associations with clinical outcomes. Results: Dissecting aneurysms involving the dominant VA were found in five patients. Of 25 aneurysms involving the non-dominant VA, 12 lesions showed involvement of the posterior inferior cerebellar artery (PICA), and one lesion’s origin was the anterior spinal artery. Stent-assisted coiling (SAC) was performed in seven patients, stent-only therapy (SOT) was conducted for six patients, and the remaining 17 patients were treated with internal coil trapping (ICT). Of the seven patients treated with SAC, five showed partial obliteration and four experienced recurrence. Two of the four patients with recurrence died. One patient with incomplete trapping for patency of the involved PICA experienced rebleeding. No recurrence was observed in six patients treated with SOT, or among 16 patients with ICT. The preoperative neurologic status (represented by the world federation of neurosurgical societies grading) and immediate post-treatment angiographic results were confirmed as significant predictive factors of clinical outcomes (P =0.018 for both variables). Conclusion: Incomplete obliteration of a ruptured VADA using SAC was associated with a higher recurrence rate and fatal clinical outcomes. ICT is a useful technique that completely eliminates the risk of rebleeding. However, under a limited set of conditions, SOT can be an effective alternative.

Original languageEnglish
Article numbere33070
JournalIranian Journal of Radiology
Volume14
Issue number2
DOIs
Publication statusPublished - 2017 Apr 1

Fingerprint

Vertebral Artery Dissection
Stents
Vertebral Artery
Therapeutics
Recurrence
Arteries
Dissecting Aneurysm
Endovascular Procedures
Fatal Outcome
Nervous System
Aneurysm

Keywords

  • Aneurysm
  • Complications
  • Embolization
  • Retrospective studies
  • Stents
  • Surgery
  • Treatment outcome
  • Vertebral artery dissection

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Endovascular treatment of ruptured vertebral artery dissecting aneurysms. / Kim, Byungjun; Lee, Nam-Joon; Kim, Keonha; Jo, Kyung Il; Jeon, Pyoung.

In: Iranian Journal of Radiology, Vol. 14, No. 2, e33070, 01.04.2017.

Research output: Contribution to journalArticle

Kim, Byungjun ; Lee, Nam-Joon ; Kim, Keonha ; Jo, Kyung Il ; Jeon, Pyoung. / Endovascular treatment of ruptured vertebral artery dissecting aneurysms. In: Iranian Journal of Radiology. 2017 ; Vol. 14, No. 2.
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AB - Background: Various endovascular treatment methods have been used to treat ruptured vertebral artery dissecting aneurysms (VADAs). However, the efficacy and long-term durability of the various endovascular techniques have remained unestablished. Objectives: The purpose of the present study is to report the therapeutic efficacy and long-term clinical and angiographic results of various endovascular treatment methods, and to evaluate the predictive factors of favorable outcomes. Patients and Methods: Between January 2010 and August 2014, 30 patients with ruptured VADAs were classified according to the dominancy of the affected vertebral artery (VA) and the involved major perforating vessels. Allotted endovascular therapy was performed for each of the ruptured VADA subtypes. Immediate angiographic and follow-up imaging results were retrospectively reviewed, and long-term clinical results were evaluated. Various clinical, angiographic, and procedural factors were evaluated to determine their associations with clinical outcomes. Results: Dissecting aneurysms involving the dominant VA were found in five patients. Of 25 aneurysms involving the non-dominant VA, 12 lesions showed involvement of the posterior inferior cerebellar artery (PICA), and one lesion’s origin was the anterior spinal artery. Stent-assisted coiling (SAC) was performed in seven patients, stent-only therapy (SOT) was conducted for six patients, and the remaining 17 patients were treated with internal coil trapping (ICT). Of the seven patients treated with SAC, five showed partial obliteration and four experienced recurrence. Two of the four patients with recurrence died. One patient with incomplete trapping for patency of the involved PICA experienced rebleeding. No recurrence was observed in six patients treated with SOT, or among 16 patients with ICT. The preoperative neurologic status (represented by the world federation of neurosurgical societies grading) and immediate post-treatment angiographic results were confirmed as significant predictive factors of clinical outcomes (P =0.018 for both variables). Conclusion: Incomplete obliteration of a ruptured VADA using SAC was associated with a higher recurrence rate and fatal clinical outcomes. ICT is a useful technique that completely eliminates the risk of rebleeding. However, under a limited set of conditions, SOT can be an effective alternative.

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KW - Complications

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KW - Retrospective studies

KW - Stents

KW - Surgery

KW - Treatment outcome

KW - Vertebral artery dissection

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