Abstract:The aim of the present study was to explore the optimal treatment strategy for patients with vertebral artery dissecting aneurysms via the endovascular approach. A total of 47 patients (50 aneurysms, including 28 ruptured and 22 unruptured) underwent endovascular treatment between January 2012 and March 2018. Of these aneurysms, 18 were treated by parent artery occlusion, 11 by stent implantation and 21 by stent-assisted coiling. The complete occlusion rate was 100% (18/18) in aneurysms treated by parent arter… Show more
“…Subarachnoid hemorrhage and ischemic stroke may occur as a result of VADA. [2] The high association of vertebral artery dissecting pseudo-aneurysm with ischemic stroke, particularly in young adults, makes it a critical diagnosis [2] .…”
Section: Discussionmentioning
confidence: 99%
“…Although vertebral artery dissecting pseudo-aneurysm is considered to be an extremely rare disease with a reported incidence of 5 per 100,000, it is more likely to be under diagnosed and more common than previously thought due to a high rate of mortality during the early stages as a result of severe hemorrhage [ 1 , 2 ]. Fig.…”
“…Subarachnoid hemorrhage and ischemic stroke may occur as a result of VADA. [2] The high association of vertebral artery dissecting pseudo-aneurysm with ischemic stroke, particularly in young adults, makes it a critical diagnosis [2] .…”
Section: Discussionmentioning
confidence: 99%
“…Although vertebral artery dissecting pseudo-aneurysm is considered to be an extremely rare disease with a reported incidence of 5 per 100,000, it is more likely to be under diagnosed and more common than previously thought due to a high rate of mortality during the early stages as a result of severe hemorrhage [ 1 , 2 ]. Fig.…”
“…Vulnerable vessel walls exposed to abnormal hemodynamics are susceptible to aneurysm growth, rupture, and recurrence (5)(6)(7). For highly involved parent artery aneurysms, coils cannot be safely and effectively used for vascular reconstruction (8). Revascularization therapy mainly relies on various stent-assisted embolization techniques presenting different procedures and recurrence risks (9,10).…”
ObjectiveThis study comparatively analyzed the hemodynamic changes resulting from various simulated stent-assisted embolization treatments to explore an optimal treatment strategy for intracranial vertebral artery fusiform aneurysms. An actual vertebral fusiform aneurysm case treated by large coil post-stenting (PLCS) was used as a control.Materials and MethodsA single case of an intracranial vertebral artery fusiform aneurysm underwent a preoperative and eight postoperative finite element treatment simulations: PLCS [single and dual Low-profile Visualized Intraluminal Support (LVIS)], Jailing technique (single and dual LVIS both simulated twice, Pipeline Embolization Device (PED) with or without large coils (LCs). Qualitative and quantitative assessments were performed to analyze the most common hemodynamic risk factors for recurrence.ResultsJailing technique and PED-only had a high residual flow volume (RFV) and wall shear stress (WSS) on the large curvature of the blood flow impingement region. Quantitative analysis determined that PLSC and PED had a lower RFV compared to preoperative than did the jailing technique [PED+LC 2.46% < PLCS 1.2 (dual LVIS) 4.75% < PLCS 1.1 (single LVIS) 6.34% < PED 6.58% < Jailing 2.2 12.45% < Jailing 1.2 12.71% < Jailing 1.1 14.28% < Jailing 2.1 16.44%]. The sac-averaged flow velocity treated by PLCS, PED and PED+LC compared to preoperatively was significantly lower than the jailing technique [PED+LC = PLCS 1.2 (dual LVIS) 17.5% < PLCS 1.1 (single LVIS) = PED 27.5% < Jailing 1.2 = Jailing 2.2 32.5% < Jailing 1.1 37.5% < Jailing 2.1 40%]. The sac-averaged WSS for the PLCS 1.2 (dual LVIS) model was lower than the PED+LC, while the high WSS area of the Jailing 1 model was larger than for Jailing 2 [PLCS 1.2 38.94% (dual LVIS) < PED+LC 41% < PLCS 1.1 43.36% (single LVIS) < PED 45.23% < Jailing 2.1 47.49% < Jailing 2.2 47.79% < Jailing 1.1 48.97% < Jailing 1.2 49.85%].ConclusionsFor fusiform aneurysms, post large coil stenting can provide a uniform coil configuration potentially reducing the hemodynamic risk factors of recurrence. Flow diverters also may reduce the recurrence risk, with long-term follow-up required, especially to monitor branch blood flow to prevent postoperative ischemia.
“…A diameter greater than 10 mm is an independent risk factor for re-bleeding of an aneurysm [8]. The preferred treatment options of DA are vessel occlusion, surgical trapping, or flow diverter [9], whereas clipping or stenting is more frequently used for SA. Some hemorrhagic SAs with hematoma and thrombus are difficult to differentiate from DA.…”
The differential diagnosis of a cerebral dissecting aneurysm (DA) and a hemorrhagic saccular aneurysm (SA) often depends on the intraoperative findings; thus, improved non-invasive imaging diagnosis before surgery is essential to distinguish between these two aneurysms, in order to provide the correct formulation of surgical procedure. We aimed to build a radiomic model based on high-resolution vessel wall magnetic resonance imaging (VW-MRI) and a machine-learning algorithm. In total, 851 radiomic features from 146 cases were analyzed retrospectively, and the ElasticNet algorithm was used to establish the radiomic model in a training set of 77 cases. A clinico-radiological model using clinical features and MRI features was also built. Then an integrated model was built by combining the radiomic model and clinico-radiological model. The area under the ROC curve (AUC) was used to quantify the performance of models. The models were evaluated using leave-one-out cross-validation in a training set, and further validated in an external test set of 69 cases. The diagnostic performance of experienced radiologists was also assessed for comparison. Eight features were used to establish the radiomic model, and the radiomic model performs better (AUC = 0.831) than the clinico-radiological model (AUC = 0.717), integrated model (AUC = 0.813), and even experienced radiologists (AUC = 0.801). Therefore, a radiomic model based on VW-MRI can reliably be used to distinguish DA and hemorrhagic SA, and, thus, be widely applied in clinical practice.
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