Endovascular treatment of bilateral intracranial vertebral artery aneurysms: an algorithm based on a 10-year neurointerventional experience

Zhang, Yisen; Tian, Zhongbin; Zhu, Wei; Liu, Jian; Wang, Yang; Wang, Kun; Zhang, Ying; Yang, Xinjian; Li, Wenqiang

doi:10.1136/svn-2020-000376

Cited by 4 publications

(4 citation statements)

References 33 publications

(36 reference statements)

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“…After title-abstract and full-text screenings (Figure 1: PRISMA flow diagram), 1095 patients from 56 studies 2–8,10–58 underwent EVT for intracranial artery dissections were included in this analysis (Table 1). The publication timeline of included studies 1999 to 2021.…”

Section: Resultsmentioning

confidence: 99%

Endovascular treatments of intracranial vertebral and internal carotid arteries dissections: An interactive systematic review and meta-analysis

2022

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Introduction Management of intracranial artery dissection (IAD) remains elusive in medical practice. Intracranially, vertebral artery dissection (VAD) is more commonly encountered than internal carotid artery dissection (ICAD). Deconstructive (EVT-d) and reconstructive (EVT-r) endovascular techniques have been utilized to treat VAD and ICAD. This meta-analysis investigates the safety and efficacy of EVT-r and EVT-d in the management of VAD and ICAD. Methods The literature was searched for all studies with consecutive patient series evaluating EVT-d or EVT-r for VAD or ICAD management. Baseline characteristics and outcomes were compared between EVT-r and EVT-d groups using the random-effect model and meta-regression approaches. Results Overall, 1095 cases pooled from 56 studies were included. There was no statistically significant difference in baseline characteristics between VAD and ICAD. EVT-r was applied in 647 cases (59.1%) and EVT-d in the rest There was no statistical difference in the rate of procedural complications between EVT-r and EVT-d. Although EVT-d was significantly associated with higher rates of complete aneurysm occlusion (86.4%), lower rates of good clinical outcomes (72.1%) and higher mortality (15.1%) were achieved compared to EVT-r (70.2%, 83.3%, and 9.5%; respectively). The mortality rate was higher, and good clinical outcomes were less common in ruptured aneurysms. Ischemic presentation was statistically associated with poor outcomes (mRS 3-5) but low mortality. ICAD often tended to grow following treatment and resulted in poor neurological outcomes. Conclusions IAD has favorable outcomes when treated appropriately. Novel reconstructive endovascular techniques are promising and should be integrated well in endovascular practice. Further studies are warranted.

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Section: Resultsmentioning

confidence: 99%

Endovascular treatments of intracranial vertebral and internal carotid arteries dissections: An interactive systematic review and meta-analysis

2022

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“…[ 5 ] Endovascular internal trapping was recently established as first-line therapy. [ 10 , 12 ] However, some retrospective studies on internal trapping revealed a high incidence of postoperative medullary infarction (30%–47%). [ 1 , 3 ] In our case, we preserved the perforating arteries originating from the VA during surgery.…”

Section: Discussionmentioning

confidence: 99%

A case of bilateral vertebral artery dissection treated by bilateral surgical occlusion and low-flow bypass

Yokoyama,

Nomura,

Ishiguro

et al. 2024

Surgical Neurology International

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Background: Bilateral vertebral artery dissection aneurysm (VADA) is a rare condition that leads to severe stroke. However, the surgical strategy for its treatment is controversial because the pathology is very complicated and varies in each case. Here, we report a case of bilateral VADA that was successfully treated with staged bilateral VADA occlusion and low-flow bypass. Case Description: A Japanese man in his 40s presented with bilateral VADA with subarachnoid hemorrhage. He had only mild headaches without any other neurological deficits. Subsequently, the ruptured left VADA was surgically trapped. However, on postoperative day 11, the contralateral VADA enlarged. The right VADA was then proximally clipped via a lateral suboccipital approach. Furthermore, a superficial temporal artery–superior cerebellar artery bypass was performed through a subtemporal approach in advance to preserve cerebral flow in the posterior circulation. The bilateral VADA was obliterated, and the patient had an uneventful postoperative course during the 1-year and 6-month follow-up period. Conclusion: Bilateral VADA can be successfully treated with staged bilateral VADA obstruction and low-flow bypass. In this case, as the posterior communicating arteries were the fetal type and the precommunicating segments of the posterior cerebral arteries (P1) were hypoplastic, a low-flow bypass was used to supply the basilar and cerebellar arteries, except the posterior cerebral and posterior inferior cerebellar arteries. Furthermore, low-flow bypass is a less invasive option than high-flow bypass.

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“…Angiographic follow-up was conducted with the magnetic resonance imaging angiography or digital subtraction angiography. The aneurysm occlusion status on imaging was assessed with the O'Kelly-Marotta (OKM) grading system ( 17 ), with the aneurysm filling grade of A - complete filling (>95%), B - incomplete (5%-95%), C - neck remnant (<5%), or D - no filling (0%).…”

Section: Methodsmentioning

confidence: 99%

“…A deconstructive approach is to surgically or endovascularly occlude the dissecting segment, but some disadvantages may be involved, including ischemic events in the case of the dominant vertebral artery being occluded, and the need of a bypass in the case of involvement of the posterior inferior cerebellar artery by the dissecting aneurysm ( 12 ). As a reconstructive technique, stent placement and stent-assisted coiling have been applied to treat intracranial vertebral artery dissecting aneurysms, with good outcomes being achieved ( 15 – 17 ). Flow diverting devices are used to reconstruct the parent artery of the aneurysm and have achieved good prognoses in the treatment of complex anterior circulation aneurysms, but their application in the posterior circulation is still in the exploratory stage.…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment of intracranial vertebral artery unruptured dissecting aneurysms: Comparison of flow diversion and stent-assisted coiling or stenting alone

Gao

et al. 2022

Front. Neurol.

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PurposeTo investigate the effect and safety of flow diverters in the treatment of unruptured dissecting intracranial aneurysms of the vertebral artery in comparison with stent-assisted coiling or stenting alone.Materials and methodsPatients with unruptured dissecting intracranial aneurysms of the vertebral artery treated with the flow diverter, stent-assisted coiling, or stenting alone were retrospectively enrolled. The clinical data were analyzed and compared.ResultsTwenty-five patients were enrolled in the flow diversion group and 42 patients in the stenting group. Twenty-six flow diverters were deployed in the flow diversion group. Immediate angiography revealed contrast agent retention within the aneurysm cavity in all patients. In the stenting group, 48 stents were deployed, and immediate angiographic outcome showed O'Kelly-Marotta (OKM) grade D in 18 (42.9%) aneurysms, grade C in 16 (38.1%), and grade B in 8 (19.0%). Periprocedural ischemic complications of thrombosis occurred in two (4.8%) patients and were treated with thrombolysis. In the flow diversion group, 19 (76%) patients underwent angiographic follow-up 3–46 (median 24) months after the procedure, with the OKM grade D in 11 (57.9%) patients, C in two (10.5%), and B in six (31.6%). The aneurysm recurrence rate was zero, and all diverters remained patent. Asymptomatic instent stenosis occurred in two (10.5%) patients. In seven of the ten patients with mild or moderate parent artery stenosis before the procedure who experienced angiographic follow-up, the stenosis was improved in five (71.4%) patients. In the stenting group, angiographic follow-up was carried out in 33 (78.6%) patients 6–58 months (median 34) after the procedure, with OKM grade D in 22 (66.7%) patients, grade C in five (15.2%), grade B in three (9.1%), and aneurysm recurrence (grade B, with increased contrast agent into the aneurysm cavity) in three (9.1%). Five (16.7%) patients experienced asymptomatic instent stenosis, and six of the 12 patients (50%) with parent artery stenosis were improved.ConclusionFlow diverters with or without selective adjunctive coiling for the treatment of unruptured dissecting intracranial aneurysms of the vertebral artery may be safe and effective with good occlusion effects not inferior to those of stent-assisted coiling and stenting alone even though the long-term effect still warrants confirmation.

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Endovascular treatment of bilateral intracranial vertebral artery aneurysms: an algorithm based on a 10-year neurointerventional experience

Cited by 4 publications

References 33 publications

Endovascular treatments of intracranial vertebral and internal carotid arteries dissections: An interactive systematic review and meta-analysis

Endovascular treatments of intracranial vertebral and internal carotid arteries dissections: An interactive systematic review and meta-analysis

A case of bilateral vertebral artery dissection treated by bilateral surgical occlusion and low-flow bypass

Endovascular treatment of intracranial vertebral artery unruptured dissecting aneurysms: Comparison of flow diversion and stent-assisted coiling or stenting alone

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