Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection

Abstract

2 Abstract PurposePrevious reports have suggested that endovascular parent artery occlusion is an effective and safe procedure for the treatment of vertebral artery dissection (VAD). However, the results of long-term outcomes are still unclear. This study reviewed the clinical and imaging outcomes of patients with VAD treated by endovascular internal trapping. MethodsA total of 73 patients were treated for VAD by endovascular internal trapping between March 1998 and March 2011. Patients were regularly followed up by magnetic resonance imaging, magnetic resonance angiography, and clinical examinations. Clinical outcomes were evaluated using the modified Rankin Scale. ResultsForty-five patients had ruptured VADs, and 28 had unruptured VADs. Clinical follow-up of at least 6 months data were obtained for 61 patients (83.6%). The follow-up period ranged from 6 to 145 months (mean ± SD, 55.6 ± 8.9 months). Two patients with ruptured VADs had recurrence (2.74%). Cranial nerve paresis (CNP) was observed in 6 patients (8.21%), spinal cord infarction in 2 patients(2.74%) and a perforating artery ischemia was diagnosed in 7 patients (9.59%); all patients with CNP and 5 of the patients with partial Wallenberg syndrome experienced only temporary symptoms; 2 of the patients with partial Wallenberg syndrome had permanent neurological deficits. Despite their symptoms, most patients were in good general condition, as shown by their clinical scores. ConclusionsThe results of this study have proven that endovascular internal trapping is a stable and durable treatment for closure of VADs. Recanalization is rather rare and occurred only in ruptured cases., both within 3months after tnitial treatment without rupture. CNP were observed in 8.21%, perforating ischemia in 9.59%, and spinal cord infarction in 2.74%. The former two are temporaly, while the last can be a factor that affect mRS. Patients rated their quality of life as good, as corroborated by their posttreatment clinical score. Endovascular internal trapping for VAD is a therapy with a satisfactory long-term outcome.

Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection

“…In studies including only patients who qualifi ed for endovascular treatment, lower mortality rates (5-9%) were reported, which is not surprising given that these studies excluded the most severe patients from the outset. 35,41 Mortality outcome in patients without subarachnoid haemorrhage is low and similar to that in patients with cervical artery dissection, ranging between none and 3% in reported series.…”

“…Sometimes, endovascular treatment is undertaken if the dissecting aneurysm has increased in size, to prevent rupture, or more rarely to reduce signs of brainstem com pression. 21,35,88,89 In children, the preferred and widespread practice is surgical or endovascular treatment in patients with intracranial artery dissection with subarachnoid haemorrhage and those without subarachnoid haemorrhage and masseff ect, whereas patients with intracranial artery dissection without subarachnoid haemorrhage and cerebral ischaemia tend to be given medical treatment. …”

“…Recurrent bleeding was reported in 0-11% of patients with intracranial artery dissection with subarachnoid haemorrhage after surgical or endovascular treatment, and after treatment for ischaemia in 0-22% of patients. 19,[21][22][23][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Cranial nerve palsies and spinal cord infarctions were seldom reported. 35,41,93 Overall, of 813 endovascular procedures, 50 (6•2%) cerebral or spinal cord ischaemia, 15 (1•8%) rupture and rebleeding, and seven (0•9%) cases of cranial nerve palsies were reported; of 125 surgical procedures, 23 (18•4%) cerebral or spinal cord ischaemia, one (0•8%) rupture and rebleeding, and one (0•8%) case of cranial nerve palsy were reported.…”

Deconstructive and Reconstructive Techniques in Treatment of Vertebrobasilar Dissecting Aneurysms: A Systematic Review and Meta-Analysis

“…Most ischemic complications are the result of occlusion and ischemia of perforating arteries and the anterior spinal artery. 13 In a series of 72 patients treated with deconstructive techniques, Kashiwazaki et al 13 reported 2 cases of spinal cord infarction and 7 cases of partial Wallenberg syndrome secondary to occlusion of vertebrobasilar dissecting aneurysms involving the PICA. Despite these perforator complications, only 1 patient died and the remaining patients had mRS Յ2.…”

The Strategy of Endovascular Treatment for Ruptured Vertebral Artery Dissecting Aneurysm, Based on Its Location Relating to the Position of the Posterior Inferior Cerebellar Artery Origin

“…[1][2][3][4][5][6][7] Although there have been recent reports documenting the effectiveness of stent-assisted coil embolization or flow diverter stent placement, [8][9][10] but parent artery occlusion remains as a safe and effective treatment, particularly in the acute phase of rupture. 11,12) To minimize the risk of re-hemorrhage and developing cerebral infarction following parent artery occlusion, it is important to make a strategy based on the location of the lesion relating to the posterior inferior cerebellar artery (PICA) origin.…”