Meta-analysis of treatment outcomes of posterior circulation non-saccular aneurysms by flow diverters

Kiyofuji, Satoshi; Graffeo, Christopher S.; Perry, Avital; Murad, M. Hassan; Flemming, Kelly D.; Lanzino, Giuseppe; Rangel-Castilla, Leonardo; Brinjikji, Waleed

doi:10.1136/neurintsurg-2017-013312

Cited by 93 publications

(75 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding clinical outcome, favorable outcome (mRS ≤2) was obtained in 59.1%, compatible with recent reports. 7,13–15) We also analyzed factors associated with favorable outcome, and 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 on multivariate analysis (Table 4). Although it is difficult to determine why male sex and use of general anesthesia were negative factors for favorable outcome, one possible explanation is that males in their 40s or 50s tend to have several risk factors for treatment, such as hypertension, diabetes mellitus, smoking, and ethanol use, as compared to females, 16) and these risk factors could have increased the rate of poor outcome.…”

Section: Discussionmentioning

confidence: 99%

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

Nakamura

Fujinaka

Nishida

et al. 2019

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Nakamura

Fujinaka

Nishida

et al. 2019

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

show abstract

“…A recently meta-analysis by Kiyofuji et al also reported higher morbidity and mortality rates of 26 and 21%, respectively (19), but the authors found that the rate of favorable neurological outcomes in vertebral artery aneurysms was higher than that for aneurysms of the mid/holobasilar and vertebrobasilar junction, indicating that flow diverters could be safely used in the vertebral aneurysms. Some previous small studies have reported favorable outcomes with the use of PED to treat non-saccular, unruptured, intradural vertebral artery aneurysms (8–10).…”

Section: Discussionmentioning

confidence: 99%

Exploring the Feasibility of Pipeline Embolization Device Compared With Stent-Assisted Coiling to Treat Non-saccular, Unruptured, Intradural Vertebral Artery Aneurysms

et al. 2019

View full text Add to dashboard Cite

Object: The pipeline embolization device (PED) has been used to treat non-saccular, unruptured, intradural vertebral artery aneurysms at some institutions. However, there is an absence of large controlled studies validating the feasibility of this treatment. This study aimed to explore the therapeutic feasibility of PED by comparing PED treatment with controlled stent-assisted coiling (SAC). Materials and Methods: Thirty-two PED procedures were matched in a 1:2 manner with 64 SAC procedures based on patient age, sex, aneurysm size, and aneurysm location. Technical factors, procedural complications, angiographic results, and clinical outcomes were analyzed and compared. Results: There was no statistically significant difference in technical factors and procedural complications between the two groups (PED vs. SAC, 9.4 vs. 4.7%, P = 0.397). In multivariate analysis, smoking and therapeutic modality were identified as independent predictors of occlusion. Smoking was a risk factor for aneurysm obliteration [hazard ratio (HR) 0.53; 95% confidence interval (CI), 0.31–0.89; P = 0.018]. Aneurysms treated with PED were more likely to achieve obliteration over time compared with aneurysms treated with SAC (HR 2.97; 95% CI, 1.79–4.93; P < 0.001). The rate of favorable clinical outcomes (modified Rankin Scale (mRS), 0–2) was similar between the two groups (PED vs. SAC, 100 vs. 96.9%, P = 0.551). In the SAC group, one patient had neurological deficit with an mRS of four at the latest follow-up. There was no mortality in either group. Conclusions: The PED and SAC groups showed similar technical factors, procedural complications, angiographic results, and favorable clinical outcomes. Aneurysms treated with PED were more prone to obliteration over time than aneurysms treated with SAC. These outcomes suggest, based on short-term follow-up, PED is a safe and feasible strategy for the treatment of non-saccular, unruptured, intradural vertebral artery aneurysms.

show abstract

“…In the VA proximal to the aneurysm, a 4.2 Fr FUBUKI catheter (Asahi Intecc) was used as an intermediate catheter and the coil was densely placed. 9) the obliteration rate of large aneurysms in the posterior circulation was 28%, and the incidence of ischemic complications was high, with a mortality rate of 27%. On the other hand, the results of PAO for dissecting VA aneurysms were favorable.…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular treatment has been increasingly indicated for non-saccular vertebral artery (VA) aneurysms. [1][2][3][4][5] Deconstructive treatment by parent artery occlusion (PAO), and internal coil trapping, [5][6][7] reconstructive treatment by stent-assisted coiling, stenting, and flow diverter, 1,3,8,9) and combined treatment consisting of endovascular treatment and direct surgery 10,11) are performed. Therapeutic strategies are selected in accordance with individual patients.…”

Section: Introductionmentioning

confidence: 99%

Internal Trapping of a Symptomatic Unruptured Giant Vertebral Artery Aneurysm Using the Coiling-in-bridging-stent Technique: A Case Report

Ishikawa

Tsutsumi

Shojima

et al. 2019

JNET

View full text Add to dashboard Cite

Objective:We report a patient in whom a devised stent-assisted internal trapping was effective to eliminate the mass effect of a symptomatic giant vertebral artery (VA) aneurysm. Case Presentation:A 63-year-old female. Detailed examination of gait disorder showed a brainstem-compressing, nonthrombotic, giant, fusiform aneurysm at an area distal to the posterior inferior cerebellar artery (PICA) bifurcation of the left VA. Endovascular internal trapping was planned, but the exacerbation of mass effects related to the coils inserted into the aneurysm cavity was concerned. Thus, before the usual internal trapping procedure, a self-expanding stent was deployed across the aneurysm to limit the coils in the stent during the internal trapping procedure. Six months later, the aneurysm decreased markedly in size with a complete relief of neurological symptom. Conclusion:Our devised stent-assisted internal trapping method, coiling-in bridging-stent technique, was successful to exclude a symptomatic giant VA aneurysm from the circulation with a minimum amount of coil in the aneurysm cavity.With this method, marked decrease in size could be expected since coils would not interfere with the shrinkage of the aneurysm. This method would be useful in giant cerebral aneurysms which need endovascular internal trapping.

show abstract

Meta-analysis of treatment outcomes of posterior circulation non-saccular aneurysms by flow diverters

Cited by 93 publications

References 21 publications

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

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

Exploring the Feasibility of Pipeline Embolization Device Compared With Stent-Assisted Coiling to Treat Non-saccular, Unruptured, Intradural Vertebral Artery Aneurysms

Internal Trapping of a Symptomatic Unruptured Giant Vertebral Artery Aneurysm Using the Coiling-in-bridging-stent Technique: A Case Report

Contact Info

Product

Resources

About