Ruptured intracranial vertebral artery dissecting aneurysms: An evaluation of prognostic factors of treatment outcome

Urasyanandana, Karanarak; Withayasuk, Pattarawit; Songsaeng, Dittapong; Aurboonyawat, T; Chankaew, Ekawut; Churojana, Anchalee

doi:10.1177/1591019917691252

Cited by 16 publications

(11 citation statements)

References 41 publications

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“…In patients with severe SAH, the percentage with favorable outcome at 30 days has certainly increased during the past decade (31.7%, 31.3%, and 56.2%, respectively), and the recent data is more robust than that of another recent report. 14) This might be due to not only earlier treatment, as shown in Table 1 (80.0% of patients were treated within 24 h in JR-NET3), but also the increase in trained neuroendovascular specialists.…”

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)

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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.

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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)

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“…The destruction technique is the most effective method to prevent aneurysm rupture and rebleeding (2,3). The immediate obliteration rate is high.…”

Section: Discussionmentioning

confidence: 99%

“…The stent-assisted coiling technique extends the usage of endovascular treatment to VADA. Endovascular treatment includes destruction (parent artery occlusion) and reconstruction techniques (stent implantation with or without coiling) (2–5). However, there is currently controversy regarding the preferred treatment option.…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment of vertebral artery dissecting aneurysm: A single‑center experience

et al. 2019

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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 artery occlusion and 46.9% (15/32) for stent implantation with or without coiling. External drainage was performed in 8 patients with ruptured aneurysms. Post-operative bleeding occurred in 2 patients treated by stent-assisted coiling. Ventriculo-peritoneal shunt was performed in 4 patients due to delayed hydrocephalus. Post-operative frontal hematoma occurred in one patient treated by stent-assisted coiling. The mortality was 6.4% (3/47) prior to discharge. The recurrence rate was 8.3% (1/12) in aneurysms treated by parent artery occlusion and 13.6% (3/22) in those treated by stent implantation with or without coiling. A total of 39 patients were followed up for 14.56±14.91 months. The good outcome rates were 100% (28/28) in patients with unruptured aneurysms and a Hunt-Hess grade of 1–3, and 72.7% (8/11) in patients with a Hunt-Hess grade of 4 or 5. In conclusion, the present study indicated that endovascular treatment is a safe and efficient method for patients with vertebral artery aneurysm. The treatment strategy should be based on the patient's condition and aneurysmal characteristics. Parent artery occlusion may be suitable for selected patients with ruptured vertebral artery aneurysms.

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“…The control injection (F-H) shows a less irregular shape of the affected V4 segment and a still markedly opacified pseudoaneurysm. (25,29). Prior experience has shown that the hemorrhageinduced platelet activation requires a tailored dosage based on response tests (e.g., Multiplate, Roche Diagnostics; VerifyNow, Accriva), with prasugrel being more efficient than ASA (30).…”

Section: Ischemic Complicationsmentioning

confidence: 99%

Flow Diversion for Reconstruction of Intradural Vertebral Artery Dissecting Aneurysms Causing Subarachnoid Hemorrhage—A Retrospective Study From Four Neurovascular Centers

et al. 2021

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Objective: Dissecting aneurysms (DAs) of the vertebrobasilar territory manifesting with subarachnoid hemorrhage (SAH) are associated with significant morbi-mortality, especially in the case of re-hemorrhage. Sufficient reconstruction of the affected vessel is paramount, in particular, if a dominant vertebral artery (VA) is impacted. Reconstructive options include stent-assisted coiling and flow diversion (FD). The latter is technically less challenging and does not require catheterization of the fragile aneurysm. Our study aims to report a multicentric experience with FD for reconstruction of DA in acute SAH.Materials and Methods: This retrospective study investigated 31 patients (age: 30–78 years, mean 55.5 years) who had suffered from SAH due to a DA of the dominant VA. The patients were treated between 2010 and 2020 in one of the following German neurovascular centers: University Hospital Leipzig, Katharinenhospital Stuttgart, BG Hospital Bergmannstrost Halle/Saale, and Heinrich-Braun-Klinikum Zwickau. Clinical history, imaging, implanted devices, and outcomes were reviewed for the study.Results: Reconstruction with flow-diverting stents was performed in all cases. The p64 was implanted in 14 patients; one of them required an additional balloon-expandable stent to reconstruct severe stenosis in the target segment. One case demanded additional liquid embolization after procedural rupture, and in one case, p64 was combined with a PED. Further 13 patients were treated exclusively with the PED. The p48MW-HPC was used in two patients, one in combination with two additional Silk Vista Baby (SVB). Moreover, one patient was treated with a single SVB, one with a SILK+. Six patients died [Glasgow Outcome Scale (GOS) 1]. Causes of death were periprocedural re-hemorrhage, thrombotic occlusion of the main pulmonary artery, and delayed parenchymal hemorrhage. The remaining three patients died in the acute–subacute phase related to the severity of the initial hemorrhage and associated comorbidities. One patient became apallic (GOS 2), whereas two patients had severe disability (GOS 3) and four had moderate disability (GOS 4). Eighteen patients showed a complete recovery (GOS 5).Conclusion: Reconstruction of VA-DA in acute SAH with flow-diverting stents is a promising approach. However, the severity of the condition is reflected by high overall morbi-mortality, even despite technically successful endovascular treatment.

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Ruptured intracranial vertebral artery dissecting aneurysms: An evaluation of prognostic factors of treatment outcome

Cited by 16 publications

References 41 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)

Endovascular treatment of vertebral artery dissecting aneurysm: A single‑center experience

Flow Diversion for Reconstruction of Intradural Vertebral Artery Dissecting Aneurysms Causing Subarachnoid Hemorrhage—A Retrospective Study From Four Neurovascular Centers

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