Endovascular Therapy for Ruptured Vertebral Artery Dissecting Aneurysms: Results from Nationwide, Retrospective, Multi-Center Registries in Japan (JR-NET3)

Abstract

Ruptured vertebral artery dissecting aneurysm (VADA) causes subarachnoid hemorrhage (SAH), and parent artery occlusion (PAO) with endovascular technique (EVT) has been the first-line treatment for ruptured VADA. In this study, we have extracted 530 ruptured VADA, treated through PAO with EVT, from a nationwide, retrospective, multi-center registration in Japan (JR-NET3), and analyzed factors associated with outcome at 30 days and procedure-related complications. Complete occlusion was achieved in 497 cases (93.8%) and favorable outcome was obtained in 303 cases (59.1%). Older age (≥60 years), male sex, use of general anesthesia, non-specialist as the responsible doctor, and time delay from onset to treatment (≥24 h) were negative factors for favorable outcome in multivariate analysis, although these factors were not associated with procedure-related complications. Compared with previous studies (JR-NET1 and 2), the number of endovascular treatments for patients with VADA and severe SAH increased in this decade; however, the percentage of patients with favorable outcome did not decrease. This might be due to not only the improvement of endovascular treatment itself, but also increased access to endovascular specialists or standardization of management.

Treatment Outcomes of Stent-Assisted Coil Embolization for Ruptured Vertebral Artery Dissecting Aneurysms: The Preservation of Branches May Improve the Prognosis

“…[1][2][3] PAO was established to prevent re-rupture as early and accurately as possible after diagnosis. 4,5) According to a multicenter registration survey (JR-NET3) 12) in Japan, deconstructive treatment group, whereas there was no significant difference in the long-term outcome. 16) As the limitations of stenting, acute occlusion or thromboembolism may occur; therefore, administration of antiplatelet drugs is necessary, and postoperative rebleeding related to administration of antiplatelet drugs or anticoagulants may develop in patients with rupture.…”

The Current Status of Endovascular Treatment for Extracranial Steno-occlusive Diseases in Japan: Analysis Using the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET3)

“…Considering the detailed information was not available from the registry, asymptomatic ischemic change, detected as small hyper-intensity spots on diffusion-weighted imaging, might be counted in the most recent study as ischemic complications, as mentioned in another JR-NET study. 14) From univariate and multivariate analysis, the procedure under general anesthesia was significantly associated with the development of complications. There is little information regarding perioperative stroke in the endovascular treatment for extracranial steno-occlusive lesions under general anesthesia, but complications or poor outcome associated with general anesthesia were reported in other lesions.…”

Stent-Jack Technique for Ruptured Vertebral Artery Dissecting Aneurysm Involving the Origin of Posterior Inferior Cerebellar Artery

“…2 ) [ 5 , 7 , 8 ] : a) PAO of the entire length of the VA and occipital artery–PICA bypass, b) proximal VA occlusion to decrease blood flow to the dissection, c) PAO with PICA stenting, and d) stenting to the VA (with coiling of the dissection). Regarding their specifics, a) is a radical, but challenging procedure, b) is relatively easy and associated with a low incidence of rerupture [ 9 ], but is not radical as the dissection remains, and c) and d) have been performed recently for a ruptured VADA involving the origin of PICA in light of developments in intracranial stents.…”